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:
- A multi-professional approach to patient care
- A structured management plan
- Scheduled patient follow-ups
- 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.