“This recommendation is really important,” said Jennifer Felder, an assistant professor of psychiatry at University of California, San Francisco, who was not on the panel. Unlike previous national guidelines, which involved screening or treatment, she noted, “this focuses on identifying women who are at risk for depression and proactively preventing its onset, using concrete guidelines.”
The panel recommended counseling for women with one or more of a broad range of risk factors, including a personal or family history of depression; recent stresses like divorce or economic strain; traumatic experiences like domestic violence; or depressive symptoms that don’t constitute a full-blown diagnosis. Others include being a single mother, a teenager, low-income, lacking a high school diploma, or having an unplanned or unwanted pregnancy, panel members said.
The panel highlighted two specific programs, which were similarly successful, Dr. Davidson said. They counsel first-time mothers and those who already have children, are available in Spanish and focus on low-income women, about 30 percent of whom develop perinatal depression, experts say.
One program, “Mothers and Babies,” includes cognitive behavioral therapy in eight to 17 group sessions, often delivered in clinics or community health centers, primarily during pregnancy with at least two sessions postpartum.
“It’s really meant to break down this idea that talking about your thoughts and behaviors is scary,” said Darius Tandon, an associate professor at Northwestern University’s Feinberg School of Medicine and principal investigator of several “Mothers and Babies” studies.
So far, health and human service agencies in over 175 counties in 21 states have been trained to implement the program. And it is being evaluated in Florida and the Midwest to see if it works when administered one-on-one by home visiting caseworkers instead of groups run by psychologists or social workers, Dr. Tandon said.
The other program, “Reach Out, Stay Strong, Essentials for New Moms” or ROSE, typically delivered in four sessions during pregnancy and one postpartum, can be administered in groups or one-on-one by nurses, midwives or anyone trained to follow the manual, said Jennifer Johnson, a professor of public health at Michigan State University.