New Recommendations May Help Prevent Depression in New Mothers
Perinatal depression refers to depression that occurs during pregnancy or following childbirth. It affects more than one in nine new mothers and can be harmful not only for the mother, but also for the infant. Despite media attention and celebrities sharing about their experiences with peripartum depression, it very often goes unrecognized and untreated.
Effective treatments are available, and counseling can be effective in preventing peripartum depression, according to new recommendations from the U.S. Preventive Services Task Force (USPSTF). The recommendations focus on actions to prevent peripartum depression especially among women at greater risk.
While it’s common to feel tired and anxious during pregnancy or with a new baby, peripartum depression involves symptoms that are severe, constant and overwhelming. Symptoms of peripartum depression may include feeling sad, hopeless or angry, lacking energy, being worried about taking care of the baby, having trouble bonding with the baby or feeling disconnected from the baby or other loved ones.
Based on a review of 50 studies, USPSTF found convincing evidence that counseling, including cognitive behavioral therapy and interpersonal therapy, is effective in preventing perinatal depression. Women who received counseling were 39 percent less likely to develop perinatal depression. Cognitive behavior therapy helps people manage negative thoughts and supports positive behaviors. Interpersonal therapy focuses on improving communication and interpersonal relationships. The counseling interventions reviewed typically involved about eight sessions over two months and they included both individual and group sessions.
While there is no standard means to identify women at higher risk of peripartum depression, based on the research USPSTF identifies women at greater risk to include women with a history of depression or with symptoms of depression but not meeting the full criteria, women with a history of physical or sexual abuse, women with little social or financial support, and women who are single or young (teens).
The USPSTF recommends that for women who are at increased risk for peripartum depression, clinicians provide or refer them to counseling. The recommendation applies to pregnant women and women who have given birth in the last year who do not have a current diagnosis of depression but are at increased risk of developing depression.
The USPSTF looked at a range of other preventive interventions, including physical activity, education, supportive intervention, medication, and other behavioral interventions, such as infant sleep training, yoga and expressive writing. While some of these interventions showed promise, the USPSTF concluded there was not enough evidence to make a recommendation at this time.
In an accompanying editorial, Lyndsay A. Avalos, Ph.D., M.P.H., acknowledged many barriers to implementing screening and preventive services for pregnant women and new mothers, but concluded the new recommendation “is an important step forward in improving the health of mothers and families affected by perinatal depression.”
O’Connor E, Senger CA, Henninger ML, Coppola E, Gaynes BN. Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA.2019;321(6):588–601.
U.S. Preventive Services Task Force. Perinatal Depression: Preventive Interventions.
Avalos, LA, Flanagan, T, De-Kun, Li. Editorial: Preventing Perinatal Depression to Improve Maternal and Child Health—a Health Care Imperative. JAMA Pediatr. Published online February 12, 2019.