Models Addressing Maternal Mental Health

A variety of mood disorders can arise around the time of childbirth. The two most common disorders are perinatal mood and anxiety disorders (PMAD) and postpartum depression (PPD). PMAD and PPD affect 15-21% of all pregnant and postpartum women in the U.S. and have the strongest evidence base for programs and interventions.

PMAD and PPD can have adverse effects on the woman, as well as her infant and family, if not identified and treated in a timely manner. The U.S. Preventive Services Task Force reported that counseling interventions such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) during and after pregnancy could be effective in successfully preventing PPD and PMAD.

Examples of Programs Addressing Maternal Mental Health

• The Reach Out, Stay Strong, Essentials for mothers of newborns (ROSE) Program focuses on reducing the risk of PPD among racially and ethnically diverse pregnant women and pregnant women with low incomes. This evidence-based educational program teaches women a variety of skills in an outpatient, group setting, and has been proven to reduce PPD cases among women with low incomes in the months following childbirth.
• Online continuing education and training that increase health professionals' awareness and knowledge of PMAD and PPD have shown positive results in improving women's health. Education sessions for healthcare providers in rural health centers, including obstetricians/gynecologists and family practice providers, have resulted in increased screening and decreased wait time for evaluating and treating women with PMAD and PPD. Research shows the importance of ensuring mental healthcare meets the cultural needs of the mother, and recommends seeking non-traditional methods of delivering care, such as providing community-engaged care.
• Some rural hospitals have started offering professional development workshops, developing hospital-wide nursing competencies, and building PMAD/PPD resource binders along with free perinatal mobile apps with a section on mental health disorders for their patients. Interventions such as these have significantly improved nurses' and patients' knowledge and behaviors.
• Video-delivered family therapy interventions aim to reduce maternal depressive symptoms and improve family functioning and emotion regulation.

Program Clearinghouse Examples

• Kansas Department of Health and Environment
• Good Beginnings of Central Vermont

Considerations for Implementation

Task shifting (redistributing healthcare delivery tasks among healthcare staff to maximize human resources), telehealth, and other remote methods (such as phone, texting, or online support groups) of perinatal mental healthcare delivery are becoming more common in rural communities where resources are limited. Task shifting provides opportunities to improve access to mental healthcare in rural communities. There are some recognized limitations and concerns — such as confidentiality and increased burden to staff — that require further study. Tele-maternal health as a method of perinatal mental healthcare delivery has been received favorably by most pregnant and new mothers, but one study found most mothers would opt for in-person therapy, if available. Other forms of remote support have identified benefits and opportunities for improvement. For example, an online support forum was found to be effective, but users reported needing added support. Text messaging was found to be an inexpensive, well-accepted form of complementary support to individuals experiencing perinatal mood disorders, but an ineffective source of primary support due to its impersonal nature and opportunity for misunderstanding.

Resources to Learn More

Behavioral Health Treatment Services Locator
Mapping System
An interactive map that allows users to identify local treatment facilities addressing substance use/addiction and/or mental health concerns across the U.S.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)

MCPAP for Moms Obstetric Provider Toolkit
Website
Assessment, screening, and treatment resources for perinatal care providers when identifying and treating mental health disorders in pre- and postpartum women.
Organization(s): Massachusetts Child Psychiatry Access Program (MCPAP)

Postpartum Depression Toolkit
Website
Designed for healthcare providers offering information on screening and diagnosis, treatment options, tips for follow-up and monitoring, and educational resources for patients. Includes Spanish language versions.
Organization(s): American Academy of Family Physicians