Interpretation
To our knowledge this is the first review about collaborative care in the setting of perinatal mental health care, which makes it difficult to compare these results with previous findings. Research in perinatal mental health care did mainly focus on the effect of psychotherapy on depressive symptoms. The predominantly positive findings of CBT and IPT are in line with previous research that showed that CBT and IPT - interventions advised by the NICE guideline - are effective in treating perinatal depression11,12,13,20,21. The treatment of women with additional psychosocial symptoms, resembling clinical practice, is less studied. A systematic review of Nillni13, et al. about the perinatal treatment of depression and anxiety disorders also included women with psychosocial problems (low-income and/or a minority status). However, this review showed, unlike our review, mixed findings of both CBT and IPT in this population. Especially the interventions with a high CCS focused on this population. This could mean that a high CCS can have a positive effect in populations with additional psychosocial symptoms.
As already noticed, collaborative care in primary care setting is effective in improving psychiatric symptoms and adherence to treatment.17,18,19 In obstetrics setting, Melville, et al. conducted an RCT, in which a multidisciplinary care intervention adapted to obstetrics and gynaecology clinics was compared with usual care. The study reported a greater improvement in psychiatric symptoms, better adherence to treatment and a greater satisfaction with care in the intervention group.67 Although there is no evidence about the role of collaborative care in the perinatal mental health care setting, this review showed the developments in the field, because almost all interventions were provided by multiple professionals. However, interventions provided by multidisciplinary teams of more than 2 different professionals (e.g., social worker) are rare. Also, remarkable is that just a few studies met the criterion of interprofessional communication. That means that obstetric care and mental health care professionals were most times both involved, but that communication, in a structured way, between them often did not take place or was not reported. Further research should focus on the effect of communication and collaboration between the different professionals, which will enable personalized medicine, including shared decision making between the patient and the different involved caregivers. Both are important in (mental) health care and will eventually lead to improved treatment adherence and more meaningful outcomes for the patient.68 Because of the low number of trials that met all collaborative care criteria, more trials are needed, to make a clear conclusion about the impact of collaborative care on maternal mental health and treatment adherence.
Last, this review shows which evidence is missing in the field of perinatal mental health care . Almost all studies were about interventions provided to women with depressive symptoms. Despite the high incidence of anxiety symptoms during pregnancy2, just 5 trials focused on women at risk of depression and anxiety. Only 3 trials were about women with tocophobia or insomnia. This shows there is a clear need for more trials on psychiatric disorders other than depression. Additionally, more research to interventions except from CBT and IPT could lead to positive consequences in the field. For example, promising results of mindfulness-based therapy were found in this review. Although there is raising awareness for child outcomes, almost all current outcomes are short-term mother or birth outcomes. Because of the negative long-term effects of perinatal mental health disorders, for future research it is recommended to examine long-term outcomes of mother and child.