[ad_1]
According to a new recommendation from the US Preventive Services Task Force (USPSTF), pregnant women and postpartum women at increased risk of perinatal depression should be referred for counseling to prevent perinatal depression.
"Counseling can help people at increased risk of perinatal depression by preventing perinatal depression before it starts or reducing the severity of depressive symptoms," said Dr. Aaron B. Caughey, Task Force member. Oregon Health and Science University, Portland, OR. , told Reuters Health by email. "It can improve the mother's quality of life, as well as the health and well-being of the baby."
Nearly one in seven women suffers from perinatal depression, one of the major complications of pregnancy and the postpartum period. Perinatal depression can have short and long-term adverse effects on the mother and the child. It is therefore important to prevent it as a public health goal.
After reviewing available evidence regarding various interventions to prevent perinatal depression, the USPSTF concluded with moderate certainty that counseling interventions, such as cognitive-behavioral therapy and interpersonal therapy, were moderately effective in preventing perinatal depression in people at increased risk.
"The task force found that we still do not have enough data on non-counseling interventions, including physical activity, education, drugs, dietary supplements, and health systems. , and we need more research to see if these interventions can help prevent perinatal depression. "said Dr. Caughey. "Dietary supplements, such as selenium and vitamin D, have shown promise, but further research is also needed in this area."
"Physicians should talk to all patients about their medical history and their home situation so that they can identify people who are pregnant or have had a baby in the last year and are at increased risk of perinatal depression", did he declare. "Then the doctor can let these patients know that they are at risk of developing depression and that there are services that have been proven to prevent it from developing. can then be administered or consult advice. "
The USPSTF's recommendation is based on a report of evidence and a systematic review conducted by Dr. Elizabeth O. Connor of the Kaiser Permanente Health Research Center in Portland, Oregon, and her colleagues. Dr. O. Connor told Reuters Health by email: "I have been surprised (and encouraged) by the breadth of research in this field. Fifty studies meet our criteria for the future." 39, inclusion, which is a pretty voluminous literature.And it was encouraging.Many counseling interventions have been tested in several studies, because we know that it is quite common that the results of a only study are not reproducible.Our confidence in the results of an intervention really grows when we see continued success after replication and can begin to understand the contexts or populations in which they work well and may not work as well well. "
"Some interventions can help prevent perinatal depression," she said. "Preventive educational counseling is probably a new concept for many people. I think most people view mental health interventions as a spoken therapy. These were more about educating, helping pregnant women find support and resources, and becoming aware of their personal vulnerabilities. "
"These are all things that most counselors are well equipped to do, as are other health practitioners, but I really think that these interventions could be widely disseminated," said Dr. O & # 39; ; Connor. "I hope that when health systems begin to implement the recommendation, they will work with researchers or program evaluation specialists to study the impact of interventions and refine them for their context and population." in a planned and thoughtful way, and that they will publish what they learn so that others can also benefit from their experience. "
Dr. Marlene P. Freeman of the Mbadachusetts General Hospital in Boston, Mbadachusetts, discussed issues related to the implementation of these recommendations. "Access to general mental health care remains a major challenge in many parts of the country, and it will be critical that multiple stakeholders, including health care providers from all disciplines, advocacy and other stakeholders, collaborate. " on how to ensure that women identified as "at risk" receive appropriate referrals and access to care. "
"In addition, it will be important to ensure that longitudinal follow-up is in place to ensure that women who suffer from perinatal psychiatric disorders despite efforts to prevent them from receiving proper care." in a timely manner, "she said. "In addition, it will be important to determine which strategies work best for different groups of women."
"If the goals of the recommendations can be achieved, women and their children could benefit tremendously," Dr. Freeman said. "However, the implementation of these recommendations poses major challenges, one of which is that screening for women at risk of perinatal depression is more difficult than screening for acute perinatal depression." To date, we do not have easy-to-use tools for doing this in a clinical setting.A number of known risk factors for perinatal depression affect a large number of women of childbearing age, but there are no simple systematic screening mechanism to determine who would benefit most from preventive treatment. "
Jennifer N. Felder, Ph.D., from the University of California at San Francisco, also discussed the opportunities and challenges badociated with implementing the USPSTF recommendations. She told Reuters Health by email: "I think the biggest hurdle to implementing the USPSTF's recommendations will be an inadequate infrastructure to allow the clinical pathway to identify people at risk of providing Fortunately, we can build on similar efforts to treat acute depression in the peri-natal period, such as the MCPAP for Moms in Mbadachusetts, which offers consultations, resources and referrals to help people with diabetes. doctors to manage depression among women in perinatality. "
"Doctors do not have to wait for a woman to experience acute depression to intervene," she said. "The most widely studied preventive interventions are cognitive behavior[al] interpersonal therapy and psychotherapy. These have been mainly studied in perinatal women with a history of depression or high depressive symptoms. As a result, physicians may want to prioritize screening for these risk factors. "
Dr. Felder added, "There are online resources to find local therapists with relevant expertise (http://bit.ly/2I9Fpsw and http://bit.ly/2I9FIUc)."
In a third editorial, Dr. Katherine L. Wisner and colleagues at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, describe a number of approaches to health systems that can prevent depression. perinatal: the interpersonal ROSE Out, Stay Strong, Essentials (ROSE) program derived from psychotherapy; home visiting programs such as Healthy Families America and the Nurse-Family Partnership; and collaborative care and provider support programs across the state.
The OPTI-MOM (Optimization of Drug Management for Depressed Mothers) study, supported by the National Institute of Health and Child Development, also aims to define the optimal dosage of antidepressants in order to avoid recurrence throughout the procreation period.
In a fourth editorial, Dr. Lyndsay A. Avalos and colleagues at the Research Division of Kaiser Permanente Northern California, Oakland, California, discuss several issues related to the implementation of the USPSTF recommendations. Doctors Avalos and Tracy Flanagan, co-author, told Reuters Health by email: "There are two main hurdles.The first is the lack of a screening tool or scoring system. to identify women at risk of perinatal depression.The successful referral of all women at increased risk of perinatal depression would exert enormous pressure on existing mental health resources that already suffer from a shortage of mental health providers. "
"The large number of women at risk of perinatal depression or depression with little or no access to health care highlights the need for evidence-based research on interventions that do not require significant resources and that Community protection and community organizations could either support development, "they said.
"The new recommendation highlights a significant and important shift from the identification and treatment of prenatal depression to prevention," they concluded. "Prevention is a key factor in improving the health of our communities, especially mothers and their children, and given limited mental health resources, we need to invest in evidence-based interventions, such as mindfulness, mobile health interventions., or peer-based programs, to evaluate their effectiveness in reducing the risk of perinatal depression in women at risk. "
Dr. Darius Tandon, badociate professor of medical social sciences and co-director of the Center for Community Health at Northwestern University's Fienberg School of Medicine, who was not involved in other publications, told Reuters Health by e-mail: Many women who do not seek care may have access to services elsewhere during the perinatal period, including home visiting programs and clinics for women, infants and children (WICs), such as those highlighted in the literature. USPSTF report, in their basic services. "
"There is also a need for greater attention to the development of sustainable reimbursement mechanisms through Medicaid for prevention services, and currently the Medicaid system is better designed to provide reimbursement for the screening and treatment of postpartum depression. ", did he declare.
Dr. Tandon added: "Rather than feel compelled to bear the full burden of meeting the mental health needs of their clients, physicians should consider working with service providers, such as visiting programs. home and other community agencies, likely to provide women who are seen by physicians as likely to develop postpartum depression with the necessary support services and mental health services. "
The USPSTF Recommendation Statement, Evidence Report and Associated Editorials appear in the February 12, 2019 issue of JAMA.
-Bill Boggs, MD
To read more, click herescdsrrwzyvudwbcasufbv.
Source link
