Scaling Up Patient-Centered Psychological Treatments for Perinatal Depression in the Wake of a Global Pandemic.

Daisy R Singla,Richard K Silver,Katarina Savel,Samantha Meltzer-Brody

doi:10.3389/fpsyt.2021.826019

Abstract

There is a call to action to reduce the public health burden of perinatal depression worldwide. The COVID-19 pandemic has further highlighted significant gaps in perinatal mental health care, especially among women who identify as Black, Indigenous, People of Color (BIPOC). While psychotherapeutic (cognitive, behavioral and interpersonal) interventions are endorsed for perinatal mood disorders, barriers to access and uptake contribute to inequitable access to treatment at the population level. To effectively address these barriers and increase the scalability of psychotherapy among perinatal women, we suggest four pragmatic questions to be answered from a patient-centered lens; namely, “who,” “what,” “how,” and “when.” Promising avenues include task-sharing among mental health non-specialists, an emphasis on culturally sensitive care, web-based delivery of psychotherapy with some caveats, and a lifespan approach to perinatal mental health. Innovative research efforts are seeking to validate these approaches in diverse contexts across North America and the UK, lending optimism toward scalable and long-term solutions for equitable perinatal mental health care.

Highlights

The past 2 years have highlighted that barriers and mental health problems are exacerbated for perinatal populations during COVID [1, 2], and even more so for women of color [3, 4]
DS drafted the initial version of this manuscript with significant contributions from SM-B, KS, and RS
The authors read and approved the final manuscript

Summary

INTRODUCTION

The past 2 years have highlighted that barriers and mental health problems are exacerbated for perinatal populations during COVID [1, 2], and even more so for women of color [3, 4]. There is a substantial gap in the existing literature on delivery of psychotherapies, including a dearth of large-scale studies, limited evaluation of the implementation of proven technological innovations and a lack of individually-tailored intervention trials [7] Overcoming this dilemma requires innovative solutions to address four salient questions; namely, “who,” “what,” “how,” and “when” evidence-based psychotherapies can be delivered from a patient-centered lens. NSP-delivered mental health interventions were shown to be effective across the globe, targeting primary care attendees, with a range of depressive symptoms, including those at high-risk based on self-report measures. These populations were ethnically diverse, including low-income and minority groups as well as urban populations. A strong emphasis in this movement is self-care, including the application of evidence-based techniques such as relaxation and mindfulness, activity scheduling and structuring, and socially connecting to promote psychological wellbeing

DISCUSSION

SUMMARY

DATA AVAILABILITY STATEMENT