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.