Janice H. Goodman, PhD.. “Perinatal depression is associated with potential negative consequences for the mother and infant, and therefore efforts to.

Women’s Attitudes, Preferences, and Perceived Barriers to Treatment for

Perinatal DepressionJanice H. Goodman, PhD.

“Perinatal depression is associated with potential negative consequences for the mother and infant, and therefore efforts to improve treatment access and efficacy are warranted” (1).

Background of the research study:

Women are twice as likely as men to experience depression during their lifetime

Childbearing women are at particularly high risk

Perinatal depression affects between 10% - 20% of women (with even higher rates among women of low socioeconomic status)

Perinatal depression can lead to a chronic or recurring depressive course throughout the woman’s life

Facts about depression in females:

Several obstetric complications and adverse birth outcomes have been associated with depression during pregnancy

Antenatal depression is the greatest risk factor for postpartum depression, which can adversely affect mother-infant interaction, infant attachment, and child development

Facts continue:

Stigma Unacceptability of treatments Financial barrier Logistical barrier (lack of time,

transportation, child care issues)

The most common barriers to mental health treatment in pregnant women

Couples counseling Relaxation techniques Exercise Peer or family support Self-care

The depression treatment preferences

Data were collected from a convenience sample of 509 predominantly Well-educated High-income Married womanin the northeastern United States during the last trimester of pregnancy

Research study population:

Age Parity Education Race/ethnicity Marital status Employment Income Immigrant status Primary language

Variables of the study:

Data were collected by means of questionnaire from a convenience sample of women recruited from the waiting rooms of two obstetrics clinics affiliated with a large urban teaching hospital in Boston, MA, from July 2006 through March 2007.

Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-rating scale developed to screen for depression in pregnant or postpartum women in community samples was used.

Methods of collection:

Women were eligible for the study if: They were in the third trimester of

pregnancy Were ages 18 years or above Could read or speak English or Spanish

Eligibility for participation:

The study questionnaire was used to collect the information about: Demographics History of depression Past and current mental health symptoms Past and current psychotropic use Potential risk factors for depression during

pregnancy (substance abuse, family history, social support)

Questionnaire:

“Have you ever had a period of 2 weeks or more when nearly every day you felt particularly sad, blue, or depressed or in which you lost all interest in things like work or social relationships?

Questionnaire:“Depression specific” question

Participants were supposed to indicate the time frame(s) of depression: Before ever being pregnant During a previous pregnancy Within 6 months after a previous pregnancy After a previous pregnancy but more than 6

months after delivery During this pregnancy but not now Currently

Questionnaire:“Depression specific” question continue:

The scale focuses on cognitive and affective features of depression rather than somatic symptoms

It has been well validated for use in obstetric populations and has a validated Spanish language version

It has a satisfactory reliability and has adequate sensitivity and specificity when compared with a psychiatric diagnosis of major depression

Edinburgh Postnatal Depression Scale (EPDS)

The authors of the EPDS recommend a cutoff score of: 9/10 for minor depression 12/13 for major postpartum depression

Edinburgh Postnatal Depression Scale (EPDS)

Assessment of: Preference of depression treatment options Stigma-related barriers Attitudes towards psychotherapeutic and

pharmacological treatments

Other important parts of the questionnaire

Individual psychotherapy Medication Family/couples therapy Group therapy Educational classes Telephone support Web- based internet support Self-help materials I’d rather wait to get over it on my own

Preference of depression treatment options

Being embarrassed to talk about personal matters with others

Being afraid of what others might think Family members might not approve

Stigma-related barriers

Attitudes were assessed by asking participants to respond to the following questions: How acceptable is it to you to seek one-on-

one counseling from a mental health professional for depression or anxiety?

How acceptable is it to you to seek group counseling for depression and anxiety?

How acceptable is it to you to take medication for depression or anxiety when pregnant?

Attitudes towards psychotherapeutic and pharmacological treatments

How acceptable is it to you to take medication when breastfeeding?

How acceptable is it to you to take medication for depression or anxiety when neither pregnant or breastfeeding?

Attitudes toward psychotherapeutic and pharmacological treatments continue:

A total of 525 women consented to take part in the study, with 509 completing the prenatal questionnaire

The mean age of participants was 31.6 years 22% of participants reported significant levels

of depressive symptoms 8.6% fell into the probable depression range 32.8% reported a previous history of

depression 14% of multiparas reported history of

postpartum depression

Results of the studySample description and mental health findings

24% indicated that they thought that they needed help during sadness and depression

21% reported having taking medication for depression in the past and/or currently, with 4.3% reporting current medication use

34% reported past and/or current non-pharmacological help for depression, with 6.5% reporting current help

A total of 8.5% were receiving medication, non-pharmacological help, or both for depression at time of assessment

Results of the studySample description and mental health findings continue:

92% endorsed individual therapy 62% indicated that group therapy was acceptable Taking medication when neither pregnant nor

breastfeeding was acceptable to 69%, compared to 33% when pregnant, and 35% when breastfeeding

69.4% indicated that they would prefer to receive treatment at the obstetrics clinic

22% reported preference to receive help from a mental health specialist at a mental health setting

Results of the studyDepression treatment preferences, acceptability, and perceived barriers to treatment

The current treatment recommendation for women who are experiencing depression during pregnancy or lactation is to carefully weigh the risks and benefits of various treatment options, and base decision on an individual woman’s health history, severity of depression, fetal gestational age or infant age, and treatment preferences.

Clinical implications

Relatively large sample size Diversity of participants Exploration of preferences Exploration of attitudes Exploration of barriers to treatment

Study strengths

Results may not be generalizable to women in types of obstetrics practices other than large hospital-affiliated practices, or in geographically different locales

Because of demographic factors (well-educated, older, high socioeconomic status, and married), the results may not be generalizable to other populations.

Study limitations

The high prevalence of depression among pregnant women, and women’s perceived need for help for emotional distress, highlights the need to develop acceptable, accessible depression interventions for diverse population of women

Conclusion

Understanding what prevents women from seeking or obtaining depression help, and determining what they prefer in the way of treatment, may lead to improved depression treatment rates and hold promise for improving the overall health of childbearing women

Conclusion

Goodman, J.H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36:1(March 2009).

References