By Dr. Chris Tonozzi, MD, Director of Data Quality
The U.S. Preventive Services Task Force recently released a recommendation related to providing counseling for mothers at risk for depression developing in the prenatal period, or while they have an infant. The recommendation provides a great goal, and an example of why a clinic system based on family medicine providers integrated with behavioral health providers is such a great solution for a community.
The task force is the publicly funded, preeminent organization in the United States which makes evidence-based recommendations on medical services. Evidence-based medicine, or EBM, is one of the true advances in modern medicine. Previously we based recommendations on what “made sense.” This was often simply what we had been using, or what we were taught to use. There have been great strides made in evaluating the interventions we use and using only the ones that have evidence of studies to support them.
The task force looked at the data from medical studies related to preventing depression in pregnant and postpartum women. The task force found that referring these women at risk for depression—rather than just those who have depression—for counseling can help prevent a significant amount of depression. The task force gave this intervention a grade B, which reflects strong evidence (although some interventions have stronger evidence) and recommends we provide this service.
The task force recommends we offer counseling to women during or after pregnancy who have one of the following risk factors:
- History of depression
- Current depressive symptoms, but not at the threshold for diagnosing depression (those diagnosed with depression are recommended for treatment)
- Low income
- Single parenthood
- Recent intimate partner violence
- Recent significant negative life events
The guideline recommends women who have one of these risk factors receive cognitive behavioral therapy or interpersonal therapy.
Mountain Family Health Centers provides prenatal care at our Edwards health center, and all our locations care for several hundred newborn babies each year. When we start care for these newborns, it is part of our routine practice to screen for depression. Now we need to start screening for the other risk factors above and have enough behavioral health appointments available to encourage counseling for patients if they have these risk factors.
It is encouraging that Mountain Family has family providers who can care for mom and infant, not to mention fathers, siblings, aunts, uncles and grandparents! With these dedicated providers working alongside behavioral health providers who can offer cognitive behavioral or interpersonal therapy. We also have a good working relationship with those who provide prenatal care in the community, so that we can be sure women already in treatment for depression can continue receiving treatment.