Scaling Up Patient-Centered Psychological Treatments for Perinatal Depression in the Wake of a Global Pandemic

Daisy R Singla; Samantha Meltzer-Brody; Katarina Savel; Richard K Silver

doi:10.3389/fpsyt.2021.826019

Scaling Up Patient-Centered Psychological Treatments for Perinatal Depression in the Wake of a Global Pandemic

Front Psychiatry. 2022 Feb 7:12:826019. doi: 10.3389/fpsyt.2021.826019. eCollection 2021.

Authors

Daisy R Singla^{1

2

3}, Samantha Meltzer-Brody⁴, Katarina Savel², Richard K Silver⁵

Affiliations

¹ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
² Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada.
³ Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁵ Department of Obstetrics and Gynecology, North Shore University Health System, University of Chicago, Chicago, IL, United States.

Abstract

There is a call to action to reduce the public health burden of perinatal depression worldwide. The COVID-19 pandemic has further highlighted significant gaps in perinatal mental health care, especially among women who identify as Black, Indigenous, People of Color (BIPOC). While psychotherapeutic (cognitive, behavioral and interpersonal) interventions are endorsed for perinatal mood disorders, barriers to access and uptake contribute to inequitable access to treatment at the population level. To effectively address these barriers and increase the scalability of psychotherapy among perinatal women, we suggest four pragmatic questions to be answered from a patient-centered lens; namely, "who," "what," "how," and "when." Promising avenues include task-sharing among mental health non-specialists, an emphasis on culturally sensitive care, web-based delivery of psychotherapy with some caveats, and a lifespan approach to perinatal mental health. Innovative research efforts are seeking to validate these approaches in diverse contexts across North America and the UK, lending optimism toward scalable and long-term solutions for equitable perinatal mental health care.

Keywords: health equity; perinatal depression; psychotherapy; task sharing; telemedicine.