The American College of Obstetricians and Gynecologists (ACOG) has established new recommendations for pregnant women, including perinatal screening for depression as well as anxiety and mood disorders. A total of 40 states already have guidelines related to this, but we are missing data in how effective the screening has been. Has it actually properly identified cases of depression and anxiety? What about the efficacy of the treatment that follows this diagnosis?

The Problem

One of the main problems is finding the resources to ensure adequate screening and treatment. Mental health care in the U.S. is lacking in many ways. Not having enough mental health providers is a big one. For this reason, obstetricians are providing this screening and treatment instead of mental health providers.

Obstetricians should be able to initiate proper care if needed but also should not hesitate to refer individuals to another specialist if needed. This is especially important for patients who have more complicated cases and necessitate a deeper evaluation.

Consider an obstetrician who has to see 20 patients every day. If 20% of the patients seen need a more thorough mental health evaluation, how do you fit that in?

So instead, you refer a patient to an outside provider. Below is a case study of one of these providers where women can be referred for specialized care.

WHCC

The Women’s Health Concerns Clinic (WHCC) in Canada is a place where women can be referred (or self-referred) for treatment. In the perinatal period, mothers are monitored for symptoms and active symptoms are treated. A social worker, registered nurse, and therapist all assess the patient. Patients are followed up to nine months postpartum. For the initial consultation, patients complete a few different questionnaires, and these are repeated during follow-up visits.

There are 4 different non-pharmacological options for patients. These include forms of CBT , psychoeducation, as well as emotional regulation skills. Individual therapies are also available to patients, as are typical pharmacologic treatments.

Of 226 patients who were referred to the center from 2015 to 2016 the following diagnosis were documented-

• 54.9% – major depressive disorder
• 43.8% – generalized anxiety disorder
• 8% – post traumatic stress disorder
• 10.2% – social anxiety disorder
• 13.7% – anxiety disorders
• 8% – bipolar disorder
• 10.2% – OCD
• 5.8% – substance use disorder
• 4% – eating disorders

Of this sample, 54% were pregnant and 44.2% were postpartum. 83.2% were in a relationship. After entering the center, 61.9% of the women were given a change in medication or dosage of their medication. 30.1% were given psychotherapy in response to their perinatal anxiety. Many of the patients had a decrease in severity of symptoms. These results were amplified for those who had more severe symptoms at the beginning.

Patients are also given access to online resources and community resources.

Looking Forward

This provides important support for the benefits that can come from specialized care. Perhaps if more individuals are referred to these centers, our nation will slowly begin to see the need for new of these organizations. A huge obstacle is cost, but collaborative treatment can help to minimize these barriers.

You can read more about this issue here.