Perinatal Psychiatry: Improving Access to Perinatal Mental Health Care

Over the past 20 years, maternal mortality in the United States has more than doubled, topping the mortality list for high-income countries. This increased rate is alarming: according to the Centers for Disease Control and Prevention, more than 700 women die each year due to complications related to pregnancy and childbirth, and more than 50,000 women suffer from a life-threatening complication. Behavioral health conditions make up a significant proportion of perinatal morbidity and increase the risk of perinatal mortality through self-harm, unintentional overdose, inadequate management of physical health, and suicide. At least half of maternal deaths in the United States are preventable; to help prevent ongoing death and suffering, stakeholders must address racial and ethnic disparities in perinatal care and reduce barriers to early health care access. Increasing access to perinatal mental health treatment will promote maternal health through improved health-related behaviors, mitigation of high-risk behaviors, and better prenatal and postnatal engagement in care.

This Editor’s Choice collection builds on the April 2019 perinatal psychiatry collection and highlights innovative service models across the care continuum, from screening to longitudinal treatment. The first set of articles details the large treatment gap for perinatal mental illness despite its association with pregnancy complications. The second set of articles discusses digital health tools (e.g., mobile apps and telepsychiatry) to support perinatal mental health screening and integrated care. The last group of articles discusses the benefits of perinatal collaborative care models in controlled trials and real-world settings in socioeconomically, racially, ethnically, and geographically diverse populations. It is incumbent upon mental health clinicians to build upon the innovations in this collection to expand access to perinatal mental health care with the goal of reversing the concerning rise in maternal morbidity and mortality.

THE TREATMENT GAP

Relationship Between Pregnancy Complications and Psychiatric Disorders: A Population-Based Study With a Matched Control Group

Kang-Yi CD, Kornfield SL, Epperson CN, et al.

Psychiatr Serv 2018; 69:300–307

DOI: 10.1176/appi.ps.201700097

Mental Health Treatment and Unmet Mental Health Care Need Among Pregnant Women With Major Depressive Episode in the United States

Sanmartin MX, Ali MM, Chen J, et al.

Psychiatr Serv 2019; 70:503–506

DOI: 10.1176/appi.ps.201800433

State Mandates Regarding Postpartum Depression^a

Rowan PJ, Duckett SA, Wang JE

Psychiatr Serv 2015; 66:324–328

DOI: 10.1176/appi.ps.201300505

USE OF TECHNOLOGY IN PERINATAL MENTAL HEALTH CARE

Evaluation of Telepsychiatry-Enabled Perinatal Integrated Care

Shore JH, Waugh M, Calderone J, et al.

Psychiatr Serv 2020; 71:427–432

DOI: 10.1176/appi.ps.201900143

Perinatal Mental Health in Community Psychiatry: A Reproductive Psychiatry eConsult Pilot Project

Dossett EC, Benitez C, Garcia N

Psychiatr Serv 2019; 70:1075–1076

DOI: 10.1176/appi.ps.201900316

Use of Text Messaging for Postpartum Depression Screening and Information Provision^a

Lawson A, Dalfen A, Murphy KE, et al.

Psychiatr Serv 2019; 70:389–395

DOI: 10.1176/appi.ps.201800269

A Mobile Application for Monitoring and Management of Depressed Mood in a Vulnerable Pregnant Population^a

Hantsoo L, Criniti S, Khan A, et al.

Psychiatr Serv 2018; 690:104–107

DOI: 10.1176/appi.ps.201600582

INNOVATION IN COLLABORATIVE CARE AND PERINATAL MENTAL HEALTH

Collaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment Response

Bhat A, Grote NK, Russo J, et al.

Psychiatr Serv 2017; 68:17–24

DOI: 10.1176/appi.ps.201600002

Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women

Grote NK, Simon GE, Russo J, et al.

Psychiatr Serv 2017; 68:1164–1171

DOI: 10.1176/appi.ps.201600411

Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program

Miller ES, Grobman WA, Ciolino JD, et al.

Psychiatr Serv 2021; 72:1268–1275

DOI: 10.1176/appi.ps.202000563

PRogram In Support of Moms (PRISM): Development and Beta Testing^a

Byatt N, Pbert L, Hosein S, et al.

Psychiatr Serv 2016; 67:824–826

DOI: 10.1176/appi.ps.201600049

Longitudinal Remote Coaching for Implementation of Perinatal Collaborative Care: A Mixed-Methods Analysis

Bhat A, Bennett IM, Bauer AM, et al.

Psychiatr Serv 2020; 71:518–521

DOI: 10.1176/appi.ps.201900341

Pregnant and Postpartum Women With Bipolar Disorder: Taking the Care to Where They Are

Bhat A, Cerimele JM, Byatt N

Psychiatr Serv 2018; 69:1207–1209

DOI: 10.1176/appi.ps.201800133