Depression During and After Pregnancy
Knowledge Path
February 2009
Introduction
This knowledge path
about depression during and after pregnancy has been compiled by the Maternal
and Child Health Library at
Georgetown University. It offers a selection of current, high-quality
resources about the prevalence and incidence of perinatal depression;
identification and treatment; impact on the health and well-being of
new mothers and their infants; and implications for service delivery.
The knowledge path is aimed at health professionals, policymakers,
program administrators, and researchers. A separate section presents
resources for women experiencing perinatal depression and their families.
This knowledge
path will
be updated
periodically.
Related topics:
Please see our knowledge path about preconception
and pregnancy and the Community
services locator: An online directory for finding community services
for children and families.
Overview
See Depression
during and after pregnancy: A resource for women,
their families, and friends
(2006). This booklet by the Health
Resources and Services Administration (HRSA) provides
information about perinatal depression and its
causes, risk factors,
symptoms, diagnosis, treatment, and effects on
families. A Spanish-language booklet (hard
copy only) can be ordered
online.
Resources for Professionals
Web
Sites
-
Healthy
New Moms: Maryland's Campaign to End Depression
During and After
Pregnancy. Presents information
and tools for this outreach campaign aimed
at increasing awareness of the signs and
symptoms of perinatal depression, providing
information on local resources, and helping
women find treatment. Includes
a helpline and patient-education materials
(available in English,
Spanish,
and Korean).
This
campaign
is presented
by
the
Mental
Health Association
of Maryland with funding from the Maternal
and Child Health Bureau and support
from the Maryland Department of Health
and Mental
Hygiene.
- Massachusetts
General Hospital Center for Women's Mental
Health: Reproductive Psychiatry Resource and
Information Center.
Presents research and program information,
bibliographies, and an electronic
newsletter about
the
evaluation
and treatment
of perinatal psychiatric disorders, including
depression.
- Maternal
and Child Health Bureau (MCHB).
Describes MCHB's initiatives on behalf of America's women, infants,
children, adolescents, and their families. MCHB is part of the Health
Resources and Services Administration (HRSA).
In addition to the MCH
Hotline and a booklet for women, resources and initiatives about perinatal
depression include
Perinatal
Depression: Emerging Perspectives and Practices.
Includes an agenda, speakers' materials, and links to additional
resources related to an MCH
DataSpeak audioconference
about perinatal depression.
Profile
of Healthy Start: Findings from phase I of the
evaluation
2006. (2008).
This report describes the first phase of a two-phase evaluation of the national
Healthy Start program. The report provides information
about the funded grantees and the implementation of the components that comprise
the program, including perinatal depression
services.
Also
see the Maternal
and Child Health Library and the Discretionary
Grant Information System (DGIS) for
additional information about the initiatives and programs
supported by MCHB that pertain to perinatal depression.
- MedEd
PPD Postpartum Depression. Presents information
and tools for health professionals to screen, diagnose, and treat
women with postpartum depression. Resources include educational
modules; a collection of slides from educational presentations;
bibliographies of classic papers, screening guidelines,
journal articles, and books; an identification and treatment
algorithm; patient-education materials in English and Spanish;
and a directory of
health professionals. MedEd PPD is a peer-reviewed Web
site developed
with the support of the National Institute of Mental
Health (NIMH).
- National
Institute of Mental Health (NIMH). Contains information
about
research,
clinical trials, funding opportunities, and training about women
and mental health and mental health conditions, such as depression
during and after pregnancy. See ClinicalTrials.gov and Computer
Retrieval of Information on Scientific Projects (CRISP) to
identify NIMH-funded research. Also see NIMH's publication for
families about women and depression.
- Perinatal
Foundation: Perinatal Depression Resources.
Presents screening tools, including tools in Hmong and Spanish,
a position statement, a continuing-education
module, fact sheets,
posters, a collection of culturally specific narratives, and
treatment
references
about
depression
during and after pregnancy. The foundation works in
partnership with the Wisconsin Association
for Perinatal
Care
to promote and implement effective perinatal practices
to improve the health of infants, mothers, and families from
preconception to early childhood. Recent publications and
initiatives include
Antidepressant
medication chart. (2008).
Madre,
Hay Esperanza (Mother, There Is Hope) Campaign. Presents information,
radio novelas, fact sheets, and a poster for this outreach initiative in Madison,
Wisconsin, to Latino families struggling with perinatal depression.
- Perinatal
Mental Health Project. Presents information
about perinatal depression and resources for screening, assessment,
and treatment that include a consultation service for health professionals,
journal articles, and PowerPoint presentations. The
project is part of the University of Illinois at Chicago and is
funded in part by the Health
Resources and Services Administration (HRSA).
Recent resources include
Depression
screening tools: Use in perinatal populations. (2007). [Chart].
Information
for physicians on prescription products to treat perinatal depression. (2007). [Medication chart].
Additional
Electronic Publications
- Ablorh-Odjidja A, Cox E, Ingoglia
JN, Joseph J, Persaud N, Phillips C, Valderama
C. 2007. Women's
mental health: Local health department strategies
in addressing depression
among pregnant and parenting women. Washington,
DC: National Association
of County and City Health Officials (NACCHO).
This issue brief highlights strategies in addressing
perinatal depression and describes the efforts of
three local health departments working to integrate
women's
mental health activities into existing services.
- Barson R. 2006. Considering
interventions for depression in reproductive
age women in family planning programs.
Baltimore, MD: Women's
and Children's Health Policy Center,
Johns Hopkins Bloomberg School of Public
Health. This policy brief focuses on screening
and interventions
for depression within family planning settings
for women of reproductive age. It gives
an overview of types of depression in women;
factors
that
may influence depression; perinatal depression;
and treatment issues such as the safety
of antidepressant use during pregnancy
and the
risks of untreated
depression during pregnancy.
- Chatterji P, Markowitz S. 2008. Family
leave after childbirth and the health of new mothers. Cambridge, MA:
National Bureau of Economic Research (NBER).
This paper examines the association
between family leave length,
which includes leave taken by
mothers and fathers, and behavioral
and physical health outcomes among
new mothers. The authors examine
measures of depression, overall
health status, and substance
use.
- Declercq ER,
Sakala C, Corry MP, Applebaum
S. 2008. New
mothers speak out: National
survey results highlight women's
postpartum experiences.
New York, NY: Childbirth
Connections. This report
presents results from two national
surveys of women who
gave birth in U.S. hospitals
in 2005. The report discusses
women's experiences from before
conception
through the early postpartum
months and explores the social,
emotional, and physical health
and workplace challenges of women
in the postpartum period. Postpartum
depression is a topic.
- Gaynes
BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody
S, Miller
WC. 2005. Perinatal
depression: Prevalence, screening accuracy, and screening outcomes.
Rockville, MD: Agency
for Healthcare Research and Quality (AHRQ). This
report presents the results of a systematic review of the evidence
on the prevalence and incidence of perinatal depression, the accuracy
of screening instruments for perinatal depression, and the effectiveness
of interventions for women at high risk for developing perinatal
depression.
- Jellinek M, Patel
BP, Froehle MC, eds. 2002. Bright
Futures in practice: Mental health.
(2 v.). Arlington, VA: National
Center for Education in Maternal and Child Health.
This guide contains information on mental health promotion and substance
use prevention for infants, children, and adolescents from birth
through age 21. It is designed to inform primary care pediatric health
professionals about the essentials of mental health promotion; to
identify the support that infants, children, and adolescents need
for good mental health; and to assist in the development and implementation
of mental-health-promotion programs and policies. A section is devoted
to postpartum mood disorders and their effects on individual and
family functioning.
- Knitzer
J, Theberge S, Johnson
K. 2008. Reducing
maternal depression and its
impact on young children:
Toward a responsive early childhood
policy framework. New York,
NY: National
Center for Children in Poverty.
This policy brief describes
the importance of addressing
maternal depression
as a central part of the effort
to ensure that all young children
enter school ready to succeed.
Topics
include how depression affects
parenting and child outcomes,
particularly for young children;
how often it occurs in combination
with
other parental risks, like post-traumatic
stress disorders; and what kinds
of strategies can prevent negative
consequences for parents, for
their parenting, and for their
young
children.
- Office
of the Surgeon General.
2008. Surgeon
General's Workshop
on Women's Mental Health:
Workshop report. Washington,
DC: Department
of Health and Human Services
(DHHS). This report summarizes
the issues addressed
at a 2005 workshop about
the critical mental health
issues affecting
girls and
women. Workshop topics included
biological and development
factors; special mental disorders;
trauma, violence, and abuse;
social stress
factors and stigma; identification and intervention issues; treatment
access and insurance; health system issues; and protective and
resilience factors. Perinatal depression is addressed.
- Oklahoma
State Department of Health.
2008. Maternal
depression after delivery in
Oklahoma. Oklahoma City,
OK: Oklahoma
State Department of Health.
This brief reports on the prevalence
of maternal
depression
symptoms
in the
postpartum
period among Oklahoma women
and makes recommendations to
address the problem. Data from
the Pregnancy
Risk Assessment Monitoring System were
used to prepare the brief.
- Olson A, Gaffney C. 2007. Parental
depression screening for pediatric
clinicians: An implementation manual.
New York, NY: Commonwealth
Fund. This
online manual provides a method for
pediatric health professionals to routinely
screen for parental depression and
to refer parents for help.
- Stillman
E. 2007. Mood
disorders and hormonal transitions: The ups and
downs. Washington,
DC: Society
for Women's Health Research. This report
summarizes a meeting convened by the Society
for Women's Health Research and the National
Institute for Mental Health to discuss current
efforts to understand the effects of hormonal
transitions, specifically pregnancy, postpartum,
and perimenopause, on the occurrence of mood
disorders in women. In addition to the report, the Society
offers the results
of a survey of women and
medical doctors to gauge their perceptions about depression in
women with an emphasis on depression through hormonal transitions,
such as pregnancy.
- Van Landeghem K. 2006. Financing
strategies for Medicaid reimbursement
of maternal depression screening
by pediatric providers.
Portland, ME: National
Academy for State Health Policy (NASHP).
This issue brief discusses strategies
for financing Medicaid reimbursement
of maternal depression screening
by pediatric health professionals.
The brief explains the relationship
between the healthy development of
young children and maternal depression,
delineates key strategies for reimbursement,
and presents a case study of reimbursement
in Illinois.
Databases
The databases listed
below are excellent tools for identifying data,
additional literature
and research,
and programs about
depression during and after pregnancy. Many of the entries below contain
tips on how to use the databases efficiently. Please note that databases
vary
in
how terms should be entered; for example, some require quotation marks
and others don't. Enter search phrases as shown in bold below.
- Data
- Literature
and Research Databases
- ClinicalTrials.gov.
Provides access to information about clinical research studies for
a wide range of diseases and conditions. Included are a summary of
the purpose of the study, recruiting status, criteria for patient
participation, location of the trial, and contact information. To
identify studies on the topic, select Search for Clinical Trials.
Enter the search phrase depression
AND (pregnancy OR postpartum OR perinatal) and click on
Search. ClinicalTrials.gov is a service of the National
Institutes of Health (NIH) and
is developed by the National
Library of Medicine (NLM).
- Cochrane
Database of Systematic Reviews.
Presents systematic reviews of health care interventions internationally.
Provides access to article abstracts. To identify reviews on
the topic, find the box, Search abstracts and summaries and enter
the search phrase depression
(pregnancy OR perinatal OR postpartum OR postnatal). Click
on Search. Access to the full-text article requires a subscription.
The
database
is
published
by
the Cochrane
Collaboration,
an international nonprofit organization based in the United Kingdom.
- Computer
Retrieval of Information on Scientific Projects (CRISP).
Contains information about federally funded biomedical research
projects conducted at universities, hospitals, and other research
institutions. Search CRISP to identify scientific concepts, emerging
trends and techniques, or specific projects and/or investigators.
To identify projects on the topic, conduct three separate searches.
Type postpartum
depression in
the search term box of the Query
Form; click on Phrase in the Global Logic field; and click
on Submit Query to get your results. Next, type perinatal
depression in
the search term box of the Query
Form; click on Phrase in the Global Logic field; and click
on Submit Query to get your results. Next, type pregnancy
depression in
the search term box of the Query
Form; click on And in the Global Logic field; and click
on Submit Query to get your results. There will be overlap in
the results. The database is maintained by the Office
of Extramural Research at the National
Institutes of Health.
- Database
of Abstracts of Reviews of Effects (DARE).
Contains summaries of systematic reviews that have met strict
quality criteria. Included reviews have to be about the effects
of interventions. Each summary also provides a critical commentary
on the quality of the review. To identify reviews on the topic,
type depression
AND (pregnancy OR perinatal OR postpartum OR postnatal) in
the search box. Click on search to get your
results. DARE is produced and maintained by the Centre for
Reviews and Dissemination at the University of York.
- Drug
Information Portal.
Presents information about more than 12,000 drugs for health
professionals, researchers, and consumers. Drug information records
include a description of the drug and links to resources for
additional information,
such
as the Drugs
and Lactation Database (LactMed). LactMed is a database
of drugs to which breastfeeding mothers may be exposed. Among
the data included are maternal
and infant levels of drugs, possible effects on breastfed infants
and on lactation, and alternate drugs to consider. The Drug Information
Portal is a service of the National
Library of Medicine (NLM).
- Maternal
and Child Health Library at
the National
Center for Education in Maternal and Child Health (NCEMCH),
Georgetown University. Maintains several databases to collect,
manage, and disseminate knowledge about MCH, with special emphasis
on knowledge gained from initiatives and programs supported by
the Maternal
and Child Health Bureau (MCHB).
The library's bibliographic database is
MCHLine®.
Comprises an online catalog of
materials in the Maternal and
Child Health Library. To identify
items on the topic, conduct two
searches. Type "postpartum
depression" in the keyword
field of the database
search form. Type the code
as it is shown and click on Search
to get your results. Conduct another
search by typing pregnan
depression in
the keyword field. Type the code
as it is shown, and click on Search
to get your results. There will
be overlap in the search results.
The Maternal
and Child Health Library also offers organizations and programs
databases.
- National
Guideline Clearinghouse (NGC).
Contains evidence-based clinical practice guidelines and related
materials for health professionals. Identify guidelines on the
topic by entering "postpartum depression" in
the search box. Click on Search to get your results. NGC
is an initiative of the Agency
for Healthcare Research and Quality (AHRQ).
- PubMed.
Contains over 18 million citations for biomedical articles that date
back to the 1950s. These citations are from MEDLINE and additional
life science journals. PubMed includes links to many sites providing
full-text articles and other related resources. To identify articles
on the topic, enter the search phrase depression, postpartum OR
(depression AND pregnancy).
Then, click on Limits and make the following selections on the page:
select a date (e.g. Published in the last 2 years); click on Humans;
click on Languages: English; and select Tag Terms: MeSH Major Topic.
Click on Go to get your results. PubMed
is a service
of the National
Library of Medicine (NLM).
- Programs Databases
- Discretionary
Grant Information System (DGIS). Contains
financial, national performance measure, and
abstract data collected annually from more
than 900 grants issued by the Maternal
and Child Health Bureau (MCHB).
To find information on grants about depression
during and after pregnancy, click on Abstracts
and conduct two searches. Enter
perinatal depression in the
search box; click on Exact Phrase; and click
on Search to get
your results. Next, enter
postpartum depression in
the search box; click on Exact Phrase; and
click on Search to get
your results. There will be overlap in the
results.
- Health
Services Research Projects in Progress (HSRProj).
Provides information about ongoing health services
research and public health projects. To identify
projects on the topic, enter the search phrase depression
AND (pregnancy OR postpartum OR perinatal).
Click on Search to get your results. HSRProj
is funded by the National
Library of Medicine (NLM).
- Maternal
and Child Health Library at
the National
Center for Education in Maternal and Child
Health (NCEMCH),
Georgetown University. Maintains two databases
to identify pregnancy-related organizations
and programs:
MCH
Organizations Database.
Lists over 2,000 government, professional, and voluntary organizations
involved in MCH activities, primarily at a national level. Type "postpartum
depression" in the keyword field of the database
search form to
identify organizations that focus on the topic. Click on Search
to get your results.
MCH
Projects Database.
Comprises an online catalog of projects funded
by the Maternal
and Child Health Bureau (MCHB).
To identify projects that focus on the topic,
type pregnan depression in
the abstract field of the database search form.
Type the code
as it is shown, and click on Search
to get your results. Final
reports are available
from several of these projects and include
Fathers,
maternal depressive symptoms, and parenting.
(2007).
Milwaukee
Healthy Beginnings Project:
Impact report. (2006).
This report describes
a Healthy Start project
to improve women's
health through screening and intervention
for depression around the time of
pregnancy.
Also see MCHB's Discretionary
Grant Information System (DGIS).
Electronic Newsletter
Resources
for Women and Their Families
Find
Care
Web
Sites for
Families
- American
Academy of Family Physicians: Postpartum Depression.
Gives
information about postpartum depression and
recovering from childbirth as well as a postpartum
depression action plan.
- Depression
and Bipolar Support Alliance (DBSA). Presents information
about perinatal depression as well as information
about treatment, finding a mental health professional, and finding
a support group.
Some
materials are available in Spanish.
- March
of Dimes (MOD): Pregnancy and Newborn Health
Education Center.
Offers information in English and Spanish about
postpartum
depression and postpartum
"blues."
- MedEd
PPD Postpartum Depression Resource. Gives information
about postpartum depression in English and Spanish. Features
an online diagnostic test; a symptoms checklist; tips for choosing
a mental
health professional;
personal stories;
answers to frequently asked
questions
from
experts in
the field;
and
a directory of health professionals.
A recent brochure is
Postpartum
depression: Looks can be deceiving ...Talk about it, treat it,
defeat it! (2006). Also available in Spanish.
- MedlinePlus:
Postpartum depression.
Gives
links to information in English and Spanish
about postpartum depression. Links
to local service providers for postpartum depression
in several states. Also presents a bilingual fact sheet about emotional
changes after giving birth. The fact sheet is written in English
on one side. The other side is written in
Arabic, Bosnian, Chinese, French, Japanese, Korean,
Marshallese, Portuguese, Russian, Somali, Spanish, Ukrainian,
and Vietnamese.
-
Postpartum
Stress Center. Presents information
and tools for women about identifying and coping with depression and
anxiety
during and after pregnancy. Includes a blog and message boards.
- Postpartum
Support International (PSI).
Contains articles, news, and legislative updates about
prenatal or postpartum mood or anxiety disorder for women and
their families. Also offers contact information for
state and local support groups and a helpline. PSI is
an international network of women, their families, and professionals
that focuses on postpartum mental health and social support.
- Indiana Perinatal
Network.
2006. Something's
not right ...You're not alone. You can
get
help ... Indianapolis, IN: Indiana
Perinatal Network. This brochure explores
the differences
between "baby blues" and depression
during and after pregnancy and explains
how perinatal mood disorders can
affect an infant. Self-help tips are
provided. Also available in Spanish.
- Maryland
Department of Health and Mental Hygiene. 2007. About
postpartum depression, rev. ed.
Baltimore, MD: Maryland
Department of Health and Mental Hygiene.
This brochure for new mothers provides
an overview of postpartum depression.
Also
available in Chinese, French, Korean, Russian,
Spanish, and Vietnamese.
- National
Institute of Mental Health (NIMH). 2008. Women
and depression: Discovering hope. Rockville, MD: National Institute of
Mental Health (NIMH). This booklet describes the symptoms, treatment, and
factors contributing to depression
that are
unique to women. Topics include postpartum depression.
- Wisconsin Association for Perinatal
Care. 2008. Women
with depression, rev. ed.
Madison, WI: Wisconsin Association for Perinatal Care.
This fact sheet is intended for women with depression to help
them plan for pregnancy. Also available in Spanish.
- See the Health
Resources and Services Administration (HRSA) booklet, Depression
during and after pregnancy: A resource for women,
their families, and friends (2006).
- Also
see the Drug
Information Portal.
Author: Susan
Brune Lorenzo, M.L.S., Maternal and Child Health Library.
Reviewers: Diana Cheng, M.D., Maryland Department of
Health and Mental Hygiene; Olivia K. Pickett, M.A.,
M.L.S., Maternal and Child Health
Library.
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