Postpartum depression (PPD) is a complex, multifaceted condition that affects approximately 1 in 7 mothers worldwide.¹ According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), PPD is diagnosed when five or more symptoms of depression occur for at least 2 weeks.² These symptoms can include depressed mood, loss of interest or pleasure, sleep disturbances, psychomotor retardation or agitation, worthlessness or guilt, loss of energy or fatigue, suicidal ideation, impaired concentration or indecisiveness, and changes in weight or appetite.² Notably, the onset of these symptoms can occur during pregnancy or up to 12 months postpartum,² and a mother may visit several healthcare professionals (HCPs) during this time frame.¹ Recognizing and addressing PPD promptly is crucial for optimizing patient outcomes, yet the condition often goes undiagnosed and untreated.¹ Implementing multidisciplinary care models can be highly effective in enhancing the identification and management of PPD.

Multidisciplinary Care Models

Multidisciplinary care models involve a team of HCPs and care staff from different disciplines working together to provide comprehensive patient care.³ In the case of PPD, this team may include primary care physicians (PCPs), obstetricians, pediatricians, psychiatrists, psychologists, nurses, lactation consultants, and others.⁴ Each professional plays a vital role in identifying and treating PPD.⁴

The Team

PCPs and obstetricians are often the first contact points in a woman’s pregnancy journey. As such, both disciplines can play an essential role in early PPD detection by screening mothers at prenatal visits, immediately after delivery, and at postnatal check-ups.

Mental health professionals, such as psychiatric specialists and therapists, can provide the necessary psychological assessment(s) and therapy to manage PPD. Their expertise is crucial in diagnosing the severity of PPD and recommending appropriate treatment modalities. They may also meet with family members to discuss adjustments to the family dynamic.⁴

Pediatricians are primarily responsible for the medical care of the infant.⁴ However, studies show that PPD can have negative impacts on young children, such as hindered infant attachment, bonding, and child development.^5–7 This can lead to cognitive, social, emotional, and behavioral problems later in life. Furthermore, children of mothers suffering from PPD demonstrate an increased use of acute healthcare services and emergency department visits.⁸ In this way, pediatricians may observe the indirect consequences of PPD.

Social workers, lactation consultants, and nurses, especially those specializing in maternity care, can offer additional support and education to mothers, helping them understand their condition and navigate the healthcare system.⁴

Community pharmacists can also play a role in promoting mental well-being and providing medication-related support to perinatal mothers.⁹

Care Protocols

The potential involvement of many professionals in different disciplines begs the question: How should postpartum care be managed? Developing and implementing standardized care protocols for PPD can ensure that all HCPs follow a consistent approach to screening, diagnosing, and treating the condition. These protocols may include:   

• Screening Tools: Using validated screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS), at regular postpartum intervals can help identify PPD early.¹⁰
• Referral Pathways: Clear referral pathways ensure that once PPD is identified, treatment can be initiated by the obstetric or primary care clinician while awaiting referral for specialized mental health services.¹¹
• Treatment Guidelines: Establishing guidelines for managing PPD, including pharmacological and non-pharmacological treatments, ensures that mothers receive evidence-based care and obstetric clinicians can safely initiate treatment for mild to moderate cases.¹²
• Follow-Up and Support: Regular follow-up appointments and establishing support networks, including peer support and counseling, can aid in the recovery process and prevent relapse.¹³

Conclusion

Operationalizing the identification of PPD through multidisciplinary care models and standardized care protocols can significantly improve the detection and management of this condition. It requires cooperation and coordination among several HCPs, but the benefits—improved health outcomes for mothers and their families—are well worth the effort. By adopting a holistic and structured approach to PPD management, mothers can receive the support and care they need during this vulnerable time.                                                                            

References:

1. Carlson K, Mughal S, Azhar Y, Siddiqui W. Postpartum depression. In: StatPearls. StatPearls Publishing; 2024. Accessed September 10, 2024. http://www.ncbi.nlm.nih.gov/books/NBK519070/
2. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association; 2022. Accessed September 25, 2024. https://www.psychiatryonline.org/dsm?doi=10.1176%2Fdsm&publicationCode=dsm
3. Janković S, Nikolic L, Marković S, Kastratović D. Multidisciplinary teams in healthcare. Hosp Pharmacol Int Multidisciplinary J. 2024;11:1370-1376. doi:10.5937/hpimj2401370J
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10. Oliveira TA, Luzetti GGCM, Rosalém MMA, Mariani Neto C. Screening of perinatal depression using the Edinburgh Postpartum Depression Scale. Rev Bras Ginecol Obstet. 2022;44(5):452-457. doi:10.1055/s-0042-1743095
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