Introduction
Globally, mental disorders during pregnancy are common, with prevalence rates of depressive and anxiety disorders around 12%1,2. Women disadvantaged by psychosocial problems are even more likely to develop mental disorders3,4, with prevalence rates of depressive disorders between 25% and 47%5. These mental disorders do not only affect pregnant women, but also have negative effects on the (unborn) child. Psychiatric symptoms are risk factors for postpartum depression, caesarean section, low birthweight and behavioural problems in late childhood6,7,8,9. There is growing evidence showing that mental disorders during pregnancy are common and have long-lasting consequences.
Current treatment options are psychotherapy and pharmacotherapy10. Because perinatal use of antidepressants may have adverse effects on child development, clinicians and women prefer psychotherapy10. Studies show that cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) can be effective in reducing perinatal psychiatric symptoms11,12. However, these therapies seem less effective for women with psychosocial problems13. Also, there is limited evidence of the long-lasting effects. Concerning the organisation of care, several barriers are identified on patient, provider and healthcare level14. Of all pregnant women diagnosed with a mental disorder, less than 10% receive adequate treatment (antidepressants or psychotherapy for >6 weeks) and less than 5% achieve remission of psychiatric symptoms15. Women with psychosocial problems are even less likely to engage in treatment16. These components make treating pregnant women with mental disorders challenging.
To overcome these challenges, there is raising awareness for integrating mental health care into obstetric care. Collaborative care plays a central role in this multidisciplinary approach consisting of obstetricians, midwives, psychiatrists, psychologists and social workers. Research has shown that collaborative care in primary care is effective in improving psychiatric symptoms and adherence to treatment17,18. A framework of collaborative care, derived from a systematic review of complex system interventions for treating depression in primary care, is designed by Gunn19 and used in different systematic reviews in order to identify key components of collaborative care in mental health care. We adapted the criteria to the obstetric care setting, in order to score interventions on the following collaborative care criteria:
  1. A multi-professional approach to patient care
  2. A structured management plan
  3. Scheduled patient follow-ups
  4. Enhanced interprofessional communication
Whether collaborative care interventions are (more) effective in treating perinatal mental disorders is unknown. The aim of this study is to review perinatal mental health interventions and describe the impact of the collaborative care criteria on maternal mental health outcomes.