Collaborative care models (CCMs) are effective in managing depression in primary care settings. However, it is unclear as to whether collaborative care models implemented in women’s health and pediatric settings are enhancing treatment for women who are at risk of perinatal depression. This review examined literature about collaborative care models for women in the perinatal period to provide insight into the promising treatment model. A systematic search resulted in n=8 studies that evaluated a total of n=7 different CCMs. Depression screening, referral processes, care coordination, treatment, and other aspects of the CCMs were examined. It can be concluded that CCMs enhance the detection of depression, treatment initiation, and engagement in services in pregnant and postpartum women. Implications and a future research agenda are presented.
Collaborative Care Model; Perinatal Depression; Care Coordination; Women’s Health; Pediatrics; Mental Health Services
Approximately 10% of women experience depression during their lifetime [1,2]. The perinatal period, which encompasses the time from pregnancy until one year postpartum, is one of the most vulnerable times for the onset of depression for women [3-6]. Prevalence rates during pregnancy are as high as 12.8% , while rates of postpartum depression range from 10% to 15% [8,9]. These statistics suggest that a significant number of women are burdened with symptoms of depression during a pivotal period for their children and themselves.
The costs associated with untreated perinatal depression (PND) are substantial. In addition to being one of the leading causes of disability amongst women and an accelerant to poor health and premature mortality [10-12], infants born to women experiencing depression have a heightened risk for reduced growth in the womb, low birth weight, and premature delivery, which are leading causes of child morbidity and mortality . Further, infants of mothers with depression demonstrate sleep difficulties, fussiness and bonding difficulties, a difficult temperament, cognitive impairment, behavior problems, and heightened anger [13-16].
Caregiver depression also affects the quality of parenting, negatively impacting parental involvement and warmth, which enhances the risk of child maltreatment [17,18].
Additionally, the chronicity associated with untreated depression makes additional episodes throughout a child’s development likely, impacting academic performance, cognitive functioning, behavior, and peer-relationships throughout childhood and adolescence [19- 21]. However, when maternal depression remits, multiple youth and family outcomes improve [22-24]. A seminal national study conducted by Weissman MM, et al. (2006) , in which 150 mother/child dyads were followed longitudinally, found significant reductions in child mental health symptoms and diagnoses among mothers who evidenced remission in depression. A follow-up study one year later found that children of mothers who experienced a remittance of depression within the first three months of treatment or over the one-year followup period had a significant reduction in mental health symptoms in comparison to children of mothers who continued to experience depression .