Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women’s concerns and treatment decision- making patterns have not been well documented. Developing a clearer understanding of women’s treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women’s preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women’s concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression. (Journal of Psychiatric Practice 2013;19:443–453)
BATTLE: Warren Alpert Medical School of Brown University, Butler Hospital, and Women & Infants’ Hospital of Rhode Island, Providence, RI; SALISBURY: Warren Alpert Medical School of Brown University and Women & Infants’ Hospital of Rhode Island; SCHOFIELD: Warren Alpert Medical School of Brown University and Skidmore College, Saratoga Springs, NY; ORTIZ- HERNANDEZ: George Washington University, Washington, DC.
The authors declare no conflicts of interest.
The following NIMH grants and awards provided support for this study and the development of this article: R34 MH079108 (Dr. Battle, Principal Investigator; Drs. Salisbury, Schofield and Ortiz-Hernandez) and K23 MH065479 (Dr. Salisbury).
Please send correspondence to: Cynthia L. Battle, PhD, Brown Department of Psychiatry and Human Behavior, Butler Hospital Psychosocial Research Program, 345 Blackstone Blvd., Providence, RI 02906. Cynthia_Battle@brown.edu