Treatment of Postpartum Depression: Recommendations for the Clinician.

Postpartum depression is a significant public health problem affecting almost 600,000 US women every year. It may arise de novo in the postpartum period or continue from pregnancy. A number of evidence-based psychotherapies and medical treatments exist for major depression and postpartum depression. The obstetrical team has many opportunities to identify high risk and depressed women and refer them to mental health professionals or begin treatment with antidepressant medication. Careful assessment of risk factors for postpartum depression during pregnancy and monitoring depressive symptoms during pregnancy and the postpartum period will lead to better outcomes for women and their families.

Validity of somatic symptoms as indicators of depression in pregnancy.

Somatic symptoms (e.g., fatigue, appetite changes, and sleep disruption) are common to both pregnancy and depression. The goal of the present study was to examine the validity of somatic symptoms as indicators of depression during pregnancy. The Inventory of Depression and Anxiety Symptoms (IDAS) was administered to a cross-sectional sample of 255 pregnant women as well as 820 women from five community-based samples, who served as a control group. Confirmatory factor analysis (CFA) was used to evaluate the fit of a single-factor model of depression in pregnant and community samples. Multigroup CFA was used to test the invariance of the factor loadings of eight depression-related symptom scales. The fit for a one-factor model was adequate for both the pregnant and community samples. All eight IDAS scales were valuable indicators of depression in the community group; however, Appetite Loss and Appetite Gain were poor indicators of depression among the pregnant women. The factor loadings for Lassitude and Appetite Gain were significantly weaker amongst the pregnant women than community women. The magnitude of the factor loadings for Insomnia and Well Being were significantly greater for the pregnant group. With the exception of appetite disturbance, somatic symptoms, though a common occurrence during pregnancy, are valid indicators of depression during pregnancy. When assessing for prenatal depression, somatic symptoms should not necessarily be dismissed as normative pregnancy experiences.

Perceived social support interacts with prenatal depression to predict birth outcomes.

Prenatal depression has been linked to adverse reproductive outcomes including preterm labor and delivery, and low birth weight. Social support also has been linked to birth outcomes, and may buffer infants from the adverse impact of maternal depression. In this prospective study, 235 pregnant women completed questionnaires about depression and social support. Clinical interviews were administered to assess for DSM-IV axis I disorders. Following delivery, birth outcomes were obtained from medical records. Babies of depressed mothers weighed less, were born earlier and had lower Apgar scores than babies of nondepressed mothers. Depressed women had smaller social support networks and were less satisfied with support from social networks. We found no direct associations between perceived social support and birth weight. However, depressed women who rated their partners as less supportive had babies who were born earlier and had lower Apgar scores than depressed mothers with higher perceived partner support. Women's perception of partner support appears to buffer infants of depressed mothers from potential adverse outcomes. These results are notable in light of the low-risk nature of our sample and point to the need for continued depression screening in pregnant women and a broader view of risk for adverse birth outcomes. The results also suggest a possible means of intervention that may ultimately lead to reductions in adverse birth outcomes.

Disseminating perinatal depression screening as a public health initiative: a train-the-trainer approach.

This case report describes the development and implementation of the Train-the-Trainer: Maternal Depression Screening Program (TTT), a novel approach to disseminating perinatal depression screening. We trained screeners according to a standard pyramid scheme of train-the-trainer programs: three experts trained representatives from health care agencies (the TTT trainers), who in turn trained their staff and implemented depression screening at their home agencies. The TTT trainers had little or no prior mental health experience so "enhanced" components were added to ensure thorough instruction. Although TTT was implemented primarily as a services project, we evaluated both the statewide dissemination and the screening rates achieved by TTT programs. Thirty-two social service or health agencies implemented maternal depression screening in 20 counties throughout Iowa; this reached 58.2% of the Iowa population. For the 16 agencies that provided screening data, the average screening rate (number of women screened/number eligible to be screened) for the first 3 months of screening was 73.2%, 80.5% and 79.0%. We compared screening rates of our TTT programs with those of Healthy Start, a program in which screening was established via an intensive consultation model. We found the screening rates in 62.5% of TTT agencies were comparable to those in Healthy Start. Our "enhanced" train-the-trainer method is a promising approach for broadly implementing depression-screening programs in agencies serving pregnant and postpartum women.