Perinatal Mental Health Screening Research Articles

Perinatal mental health and active-duty military spouses: a scoping review

IntroductionMental health conditions (i.e. depression or anxiety) are the most common complication of pregnancy and childbirth in the United States (U.S.) and are associated with increased maternal and infant morbidity and mortality. Research has demonstrated a relationship between stress and mental health diagnoses in pregnancy; therefore, it is concerning that military families face unique challenges which contribute to additional stressors among spouses of active-duty (AD) military personnel during the perinatal period. The objective of this scoping review was to understand the current state of research on perinatal stress or perinatal mental health among American spouses of AD military personnel.MethodsThe Boolean phrase was created in consultation with 2 health science librarians and the following databases searched in October 2023: PubMed, Embase, Military and Government Collection, CINAHL, and PsychINFO. 2 reviewers identified 481 studies for screening once duplicates were removed. After applying inclusion and exclusion criteria, 21 studies remained for data extraction and analysis.ResultsMost of the studies were quantitative, took place in the southern U.S., and the most represented military branch was Air Force. Most of the studies included both AD military members and AD spouses; 28% focused solely on AD spouses. Samples were not racially diverse, and findings identified racial disparities in perinatal mental health conditions. There was a wide variety in outcome measures, including the following general categories: (1) stress, anxiety, and/or depression, (2) maternal-infant attachment, (3) group prenatal care, and (4) deployment focus. Our review identified the following concepts: spouses most at risk for perinatal mental health conditions, the need for perinatal mental health screening, and the need for social support.ConclusionsFindings from the identified studies indicate a need for additional research in this area. Additionally, findings highlight circumstances unique to this population that result in an increased risk of stress and/or mental health conditions during the perinatal period. Such challenges demand improved mental health screening and additional resources for this population. Meeting the needs of this unique population also requires significant funding and policy change to allow for increased access to mental health resources and to ensure the health of the birthing person and infant.

From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women

BackgroundMany women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. MethodsParticipants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. ResultsMixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LimitationsOnly a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. ConclusionsResults highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.

The prevalence of perinatal mental health disorders and psychosocial characteristics of women in Malta: A cross-sectional study.

Perinatal mental health disorders (PMHDs) are associated with a myriad of negative outcomes for women, infants, and the rest of the family unit. Understanding the prevalence of these conditions is important to guide prevention and treatment pathways. Indeed, the burden of PMHDs has been studied in many countries, but for Malta, an island with an annual birth rate of 4500 births, this burden is still to be determined. The main objective of this study was to address this gap, determine the prevalence of PMHDs among postpartum women in Malta, and study associated psychosocial determinants for this population. A cross-sectional epidemiological study was conducted between March and April 2022 to determine the point prevalence of postpartum PMHDs in Malta. A representative, random sample of 243 postnatal mothers were recruited and screened for mental health issues using a two stage approach incorporating symptom scales and a diagnostic interview. The point prevalence of postnatal PMHDs in Malta, according to a diagnostic interview, was found to be 21.4%. Anxiety disorders were the most prevalent conditions (16.8%), followed by obsessive-compulsive disorder (6.1%) and borderline personality disorder (5.6%), respectively. A higher rate of 32.1% was identified with self-report measures. PMHDs are highly prevalent, affecting approximately 20% of women in Malta across the first postnatal year. The value of this finding accentuates the need for service availability and the implementation of perinatal mental health screening programs.

Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A).

There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population. 161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated. The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A. Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

Perinatal common mental health disorders among migrant women: a systematic review and meta-analysis

Abstract Background Pregnant migrants are particularly vulnerable to mental illness because they are exposed to stressors including conflict, poverty, and discrimination. We aimed to assess the global prevalence of perinatal mental health disorders or substance use among migrant women. Methods We searched MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in the perinatal period or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal mental health disorders amongst migrant women globally. A random-effects meta-analysis was used to calculate pooled prevalence estimates. PROSPERO: CRD42021226291. Results 18,650 studies were retrieved, of which 135 studies (comprising data from 621,995 participants) met the inclusion criteria. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all migrant women, 32·5% (1·5-81·6; 98·7%; τ2 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; τ2 0·01) among economic migrants (p < 0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Conclusions One in four migrant women who are pregnant or postpartum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher amongst forced migrant women compared to economic migrants. These findings highlight the need for community-based perinatal mental health screening and access to interventions that are culturally sensitive. Key messages • Women who are forced migrants have a higher prevalence of perinatal depressive disorders compared with women who are economic migrants; forced migrants also experience a high burden of PTSD. • The findings highlight the need for culturally sensitive mental health screening and care for migrant women who are pregnant or postpartum, particularly for forced migrants.

Perinatal mental health screening for women of refugee background: Addressing a major gap in pregnancy care.

Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non-refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non-refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non-refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). Similarly, high proportions of women of refugee and non-refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care.

The perceptions and attitudes of obstetric staff and midwives towards perinatal mental health disorders screening: a qualitative exploratory study in Shenzhen, China

BackgroundThe perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable time, there is a high prevalence of depressive and anxiety disorders among pregnant women. In 2019, the Health Commission of Shenzhen initiated perinatal mental health screening programme in China. However, attitudes and perceptions of medical staff towards implementing mental health screening programme during pregnancy remain unclear. The aim of this study was to explore the perceptions and attitudes of obstetric staff and midwives towards screening for perinatal mental disorders in pregnant women, and identify their perceived needs and motivations for undertaking this task.MethodsThis is a qualitative exploratory study. Data were collected through in-depth, semi-structured, face-to-face interviews. The dataset was analysed using inductive content analysis. Purposive sampling method was used to recruit 13 participants at a tertiary maternal hospital in Shenzhen from September to November, 2019.ResultsA total of 13 obstetric staff was interviewed, including two obstetricians, three midwives, and eight nurses. Four themes were identified from this study: views on perinatal mental health disorders screening, competency in identifying and supporting high-risk groups, barriers to dealing with psychological problems during pregnancy, and the support needs of medical staff in undertaking the tasks of mental health disorders screening.ConclusionMedical staff lacked sufficient knowledge and skills in perinatal psychological health and were not well prepared for the task of screening pregnant women for mental health disorders. To address this issue, medical organisations and relevant government sectors should provide training to medical staff on perinatal mental health disorders, enhance public awareness of perinatal mental health disorders, establish a model of multidisciplinary collaboration for the screening of women’s perinatal mental disorders, and provide continuous and holistic care for pregnant women.

Development of the Edinburgh Postnatal Depression Scale-United States: An Updated Perinatal Mental Health Screening Tool Using a Respectful Care and Trauma-Informed Approach.

Purpose: To present the development protocol of the Edinburgh Postnatal Depression Scale-United States (EPDS-US), an adapted version of the EPDS, that is inclusive and easy to understand for U.S. populations and incorporates a trauma-informed approach to perinatal mental health (PMH). Methods: Our team adapted the wording of the original EPDS to be more linguistically appropriate for current use with U.S. populations by incorporating principles from Trauma-Informed Care and the Cycle to Respectful Care. Results: Through small but impactful linguistic updates, the EPDS-US offers inclusive person-first language and eliminates confusing phrases or wording that may be perceived as judgmental. The goal of the adapted EPDS-US is to foster symptom disclosure in an environment of safety and trust. The EPDS-US removes preidentified barriers patients experience related to PMH screenings. Conclusions: The EPDS-US, a trauma-informed and respectful care screening tool, may lead to earlier recognition of symptoms, may allow for more person-focused treatment plans, and may serve as a platform for a culture change in addressing PMH, particularly when the screening tool is accompanied by open conversation, education, and resources. Validation studies are required at this time and this team welcomes direct communication with research and clinical sites interested in doing so.

To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening

This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation “against instrument-based depression screening using a questionnaire with cut-off score to distinguish ‘screen positive’ and ‘screen negative’ administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth).” While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for “de-implementation” of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.

Mental Health Screening for Refugee Minority Ethnic Women in the UK

The importance of assessing mental health during and after pregnancy is being increasingly recognised. Rates of mental health problems during and after pregnancy are higher among those from minority ethnic groups living in the United Kingdom (UK) compared with White British women and birthing people. However, there are cultural differences in understanding mental health struggles, acceptability of admitting symptoms and willingness to accept help. This paper explores the literature about perinatal mental health screening for minority ethnic women and birthing people in the UK.

The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis

There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.

African Immigrant Mothers' Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study.

Mental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care. The purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers' views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers' views regarding perinatal mental health screening and to determine factors associated with those views. A cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ≥18 years, had a live birth, and the infant was aged ≤2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted. Among the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability. Although African mothers' knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health.

Impact of the COVID-19 pandemic on perinatal mental health screening, illness and pregnancy outcomes: A cohort study.

The aim was to explore the impact of the COVID-19 pandemic on perinatal mental health screening, illness and related pregnancy complications/outcomes. A single-centre retrospective cohort study in mothers giving birth before versus during the pandemic. Primary outcomes were the comparative prevalence/incidence of peripartum psychiatric diagnoses. Secondary outcomes were the pandemic's effect on psychiatric screening accuracy, and on other pregnancy outcomes linked to mental health. The pandemic did not significantly increase the crude incidence of diagnosed peripartum anxiety (risk ratio (RR) = 1.39, 95% CI = 0.66-2.95), depression (RR = 1.63, 95% CI = 0.72-3.70) or other pregnancy outcomes. In multivariate models, the pandemic decreased Apgar scores and was involved in interaction effects for postpartum mental illness and birthweight. Psychiatric screening at the booking appointment exhibited lower sensitivity in predicting antenatal mental illness (pre-pandemic = 85.71%, pandemic = 25.00%; p = 0.035). The lowered screening sensitivity likely meant mental illness was poorly anticipated/under-detected during the pandemic, leading to no crude increase in perinatal psychiatric diagnoses.

Assessment of Canadian perinatal mental health services from the provider perspective: Where can we improve?

PurposePerinatal mental health disorders are common, and rates have increased during the COVID-19 pandemic. It is unclear where providers may improve perinatal mental health care, particularly in countries lacking national guidelines, such as Canada.MethodsA cross-sectional survey of perinatal health providers was conducted to describe the landscape of perinatal mental health knowledge, screening, and treatment practices across Canada. Providers were recruited through listservs, social media, and snowball sampling. Participants completed an online survey that assessed their perinatal mental health training, service provision types, their patient wait times, and treatment barriers, and COVID-19 pandemic-related impacts.ResultsA total of 435 providers completed the survey, including physicians, midwives, psychologists, social workers, nurses, and allied non-mental health professionals. Most (87.0%) did not have workplace mandated screening for perinatal mental illness but a third (66%) use a validated screening tool. Many (42%) providers stated their patients needed to wait more than 2 months for services. More than half (57.3%) reported they did not receive or were unsure if they received specialized training in perinatal mental health. Most (87.0%) indicated there were cultural, linguistic, and financial barriers to accessing services. Over two-thirds (69.0%) reported the COVID-19 pandemic reduced access to services.ConclusionSurvey findings reveal significant gaps in training, screening tool use, and timely and culturally safe treatment of perinatal mental health concerns. There is critical need for coordinated and nationally mandated perinatal mental health services in Canada to improve care for pregnant and postpartum people.

Introducing and integrating perinatal mental health screening: Development of an equity-informed evidence-based approach.

Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines, but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings and to synthesize the learnings from an implementation initiative and multisectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a nongovernmental organization (NGO) commissioned to update the Australian perinatal mental health guidelines, train health professionals and implement digital screening. In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening programme for depression and anxiety with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies that were identified preimplementation and postevaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organizations. Using a behavioural change framework (Capability, Opportunity, Motivation-Behaviour Model), the key barriers, processes and outcomes are described for a real-world example designed to maximize accessibility, feasibility and acceptability. A Programme Logic Model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development and a digital screening platform, with the outcomes of the programme. A seven-stage implementation guide is presented for use in a range of healthcare settings. These findings describe an equity-informed, evidence-based approach that can be used by healthcare organizations to address common systems and individual-level barriers to implement perinatal depression and anxiety screening guidelines. These results present strategies that were informed by prior research involving patients and staff from a large public antenatal clinic in Melbourne, Australia. This involved interviews with health professionals from the clinic such as midwives, obstetricians, perinatal mental health and refugee health experts and interpreters. Interviews were also conducted with women of refugee background who were attending the clinic for antenatal care. A steering committee was formed to facilitate the implementation of the perinatal mental health screening programme comprising staff from key hospital departments, GP liaison, refugee health and well-being, the NGOCOPE and academic experts in psychology, midwifery, obstetrics and public health. This committee met fortnightly for 2 years to devise strategies to address the barriers, implement and evaluate the programme. A community advisory group was also formed that involved women from eight different countries, some of refugee background, who had recently given birth at the health service. This committee met bimonthly and was instrumental in planning the implementation and evaluation such as recruitment strategies, resources and facilitating an understanding of the cultural complexity of the women participating in the study.

MHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework.

BackgroundThe ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options.ObjectiveThis study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework.MethodsFollowing a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use.ResultsMost apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results.ConclusionsThese results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support.

Perinatal Psychiatry: Improving Access to Perinatal Mental Health Care.

Back to table of contents Previous article Next article Editor's ChoiceFull AccessPerinatal Psychiatry: Improving Access to Perinatal Mental Health CareKunmi Sobowale, M.D., Misty Richards, M.D., M.S., Lisa B. Dixon, M.D., M.P.H.Kunmi SobowaleSearch for more papers by this author, M.D., Misty RichardsSearch for more papers by this author, M.D., M.S., Lisa B. DixonSearch for more papers by this author, M.D., M.P.H.Published Online:1 Jan 2022https://doi.org/10.1176/appi.ps.2021.73102AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This Editor’s Choice collection was published online in November 2021 and refreshes the original April 2019 collection on perinatal psychiatry. To review all collections, please visit the Editor’s Choice section of ps.psychiatryonline.org.Over the past 20 years, maternal mortality in the United States has more than doubled, topping the mortality list for high-income countries. This increased rate is alarming: according to the Centers for Disease Control and Prevention, more than 700 women die each year due to complications related to pregnancy and childbirth, and more than 50,000 women suffer from a life-threatening complication. Behavioral health conditions make up a significant proportion of perinatal morbidity and increase the risk of perinatal mortality through self-harm, unintentional overdose, inadequate management of physical health, and suicide. At least half of maternal deaths in the United States are preventable; to help prevent ongoing death and suffering, stakeholders must address racial and ethnic disparities in perinatal care and reduce barriers to early health care access. Increasing access to perinatal mental health treatment will promote maternal health through improved health-related behaviors, mitigation of high-risk behaviors, and better prenatal and postnatal engagement in care.This Editor’s Choice collection builds on the April 2019 perinatal psychiatry collection and highlights innovative service models across the care continuum, from screening to longitudinal treatment. The first set of articles details the large treatment gap for perinatal mental illness despite its association with pregnancy complications. The second set of articles discusses digital health tools (e.g., mobile apps and telepsychiatry) to support perinatal mental health screening and integrated care. The last group of articles discusses the benefits of perinatal collaborative care models in controlled trials and real-world settings in socioeconomically, racially, ethnically, and geographically diverse populations. It is incumbent upon mental health clinicians to build upon the innovations in this collection to expand access to perinatal mental health care with the goal of reversing the concerning rise in maternal morbidity and mortality.THE TREATMENT GAPRelationship Between Pregnancy Complications and Psychiatric Disorders: A Population-Based Study With a Matched Control GroupKang-Yi CD, Kornfield SL, Epperson CN, et al.Psychiatr Serv 2018; 69:300–307DOI: 10.1176/appi.ps.201700097Mental Health Treatment and Unmet Mental Health Care Need Among Pregnant Women With Major Depressive Episode in the United StatesSanmartin MX, Ali MM, Chen J, et al.Psychiatr Serv 2019; 70:503–506DOI: 10.1176/appi.ps.201800433State Mandates Regarding Postpartum DepressionaRowan PJ, Duckett SA, Wang JEPsychiatr Serv 2015; 66:324–328DOI: 10.1176/appi.ps.201300505USE OF TECHNOLOGY IN PERINATAL MENTAL HEALTH CAREEvaluation of Telepsychiatry-Enabled Perinatal Integrated CareShore JH, Waugh M, Calderone J, et al.Psychiatr Serv 2020; 71:427–432DOI: 10.1176/appi.ps.201900143Perinatal Mental Health in Community Psychiatry: A Reproductive Psychiatry eConsult Pilot ProjectDossett EC, Benitez C, Garcia NPsychiatr Serv 2019; 70:1075–1076DOI: 10.1176/appi.ps.201900316Use of Text Messaging for Postpartum Depression Screening and Information ProvisionaLawson A, Dalfen A, Murphy KE, et al.Psychiatr Serv 2019; 70:389–395DOI: 10.1176/appi.ps.201800269A Mobile Application for Monitoring and Management of Depressed Mood in a Vulnerable Pregnant PopulationaHantsoo L, Criniti S, Khan A, et al.Psychiatr Serv 2018; 690:104–107DOI: 10.1176/appi.ps.201600582INNOVATION IN COLLABORATIVE CARE AND PERINATAL MENTAL HEALTHCollaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment ResponseBhat A, Grote NK, Russo J, et al.Psychiatr Serv 2017; 68:17–24DOI: 10.1176/appi.ps.201600002Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged WomenGrote NK, Simon GE, Russo J, et al.Psychiatr Serv 2017; 68:1164–1171DOI: 10.1176/appi.ps.201600411Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care ProgramMiller ES, Grobman WA, Ciolino JD, et al.Psychiatr Serv 2021; 72:1268–1275DOI: 10.1176/appi.ps.202000563PRogram In Support of Moms (PRISM): Development and Beta TestingaByatt N, Pbert L, Hosein S, et al.Psychiatr Serv 2016; 67:824–826DOI: 10.1176/appi.ps.201600049Longitudinal Remote Coaching for Implementation of Perinatal Collaborative Care: A Mixed-Methods AnalysisBhat A, Bennett IM, Bauer AM, et al.Psychiatr Serv 2020; 71:518–521DOI: 10.1176/appi.ps.201900341Pregnant and Postpartum Women With Bipolar Disorder: Taking the Care to Where They AreBhat A, Cerimele JM, Byatt NPsychiatr Serv 2018; 69:1207–1209DOI: 10.1176/appi.ps.201800133a Article from the April 2019 Editor’s Choice on Perinatal Psychiatry FiguresReferencesCited byDetailsCited byNone Volume 73Issue 1 January 01, 2022Pages 116-117 Metrics PDF download History Published online 1 January 2022 Published in print 1 January 2022

Perinatal Mental Health Task Force: Integrating Care Across a Pediatric Hospital Setting.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide a leading cause of postpartum deaths. PMADs are associated with poor maternal, infant, and family outcomes. Identification and early intervention are imperative for successful treatment. This case study describes the implementation and outcomes of a multidisciplinary Perinatal Mental Health Task Force ("Task Force") at one urban academic children's hospital that was created to promote systems change and health care policy solutions for improved identification and treatment of PMADs. Using the social ecological model as a framework, the Task Force addressed care at the individual, interpersonal, organizational, community, and policy levels. The Task Force applied lessons learned from division-specific screening initiatives to create best practices and make hospital-wide recommendations. This foundational work enabled us to build community bridges and break down internal barriers to shift our pediatric hospital toward prioritizing perinatal mental health. As a result, screening expanded to multiple hospital locations and became a hospital corporate goal, the Perinatal Mental Health Screening Tool Kit was created and disseminated within the community, Task Force members testified in governmental hearings and joined national organizations to inform policy, and Task Force and community collaborations resulted in significant grant funding. Lessons learned have been disseminated nationally. Moving forward, we aim to expand our program and partnerships to ensure that caregivers of infants receive appropriate mental health support to strengthen family well-being. The Task Force can serve as a model for advocates looking to expand and integrate PMAD care.

Can the Edinburgh Postnatal Depression Scale-3A be used to screen for anxiety?

BackgroundAnxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. Therefore, perinatal mental health screening programs should not only focus on depression but also on detecting anxiety. However, in many already implemented perinatal screening programs, adding extra screening instruments is not feasible. We examine the utility of a subscale of the Edinburgh Postnatal Depression Scale (EPDS) consisting of items 3, 4, and 5 (EPDS-3A) for detecting anxiety in new mothers.MethodsWe used confirmatory factor analysis (CFA) to confirm the presence of the EPDS-3A found in a previous study (n = 320) where exploratory factor analysis (EFA) was used. For the CFA we used a sample of new mothers (n = 442) with children aged 2–11 months recruited from the same population from which mothers for the previous study was recruited. Three models were tested and compared. Receiver operating characteristics of the EPDS-3A were investigated in relation to anxiety caseness status on the combined sample (N = 762). Sample weighing was used to match the dataset to the target population. Cross tabulation was used to investigate the proportion of anxiety cases identified by the EPDS-3A above those identified with the total EPDS.ResultsThe presence of the EPDS-3A was confirmed. An EFA-driven, two-dimensional 7-item model showed the best data fit with one factor representing the anxiety subscale consisting of items 3, 4, and 5. An EPDS-3A score of ≥ 5 was the most optimal for identifying cases of anxiety (sensitivity: 70.9; specificity: 92.2; AUC: 0.926). Further, we found that the EPDS-3A identifies an additional 2.5% of anxiety cases that would not have been identified with the total EPDS.ConclusionsThe EPDS-3A can be used as a time-efficient screening for possible anxiety in ante- and postnatal mothers. However, adding the EPDS-3A to routine screening with the total EPDS does not lead to a substantial increase in the number of women identified. In line with previous studies, this study confirms that the EPDS identifies anxiety in addition to depression. Therefore, assessment and treatment adjusted to the specific emotional difficulties is imperative.

Perinatal depression.

Perinatal depression is a common and debilitating complication of pregnancy and childbirth. Recent studies have elucidated relationships between acute birth events on depression risk, and novel treatments for postpartum depression have been discovered and approved. This article reviews current understandings about birth events on depression, new screening standards, and novel treatments for postpartum depression. Pain, analgesia, and depression are complex traits that are inter-related during and after pregnancy. Certain individuals may benefit more than others from addressing pain and suffering around childbirth. Exposures to general anesthesia or postdural puncture headache are associated with postpartum depression symptoms, although a causal relationship is unlikely. Brexanolone, ketamine and its related compounds, and nonpharmacologic options offer new or alternative therapies for depression, although safety information for some of these treatments in pregnancy and lactation are needed. Maternal health bundles call for close attention to perinatal mental health screening with validated instruments, and for timely treatment referrals in the 'fourth trimester'. Clinical monitoring and timely treatment of depression in the perinatal and postpartum periods is critical for maternal postpartum health and recovery. Perinatal specialists and researchers should continue to focus on tailored treatments specific to this special population.