Is collaborative care a key component for treating pregnant women with
psychiatric and psychosocial symptoms?: A systematic review.
Abstract
Background: Mental disorders during pregnancy are common, with
long-lasting negative effects on mother and child. The combination with
psychosocial symptoms, barriers on population and healthcare level and
lack of long-term evidence make treatment challenging. To overcome this,
there is raising awareness for collaborative care. Objectives: Review
perinatal mental health interventions and analyse the impact of
collaborative care. Search strategy: Two independent reviewers searched
for RCT’s in Pubmed, Embase and PsycINFO. Selection criteria: Trials
studying the effect of psychological or pharmacological interventions on
the mental health of pregnant women with psychiatric and/or psychosocial
symptoms. Data collection and analysis: Two reviewers independently
abstracted data and assessed study quality and risk of bias. Each study
was scored on collaborative care criteria: multi-professional approach
to patientcare, structured management plan, scheduled patient
follow-ups, enhanced interprofessional communication. Main results: 35
studies were included. Most trials studied the effect of cognitive
behavioural therapy and interpersonal psychotherapy on perinatal
depression. Almost all interventions met at least one collaborative care
criteria. Interventions were mostly provided by multiple professionals,
but interprofessional communication rarely took place. Interventions
that met more criteria did not more often show a positive effect on
maternal mental health. Conclusions: There is lack of research on
perinatal psychiatric disorders other than depressive and on long-term
treatment outcomes. Collaborative care is partly implemented in most
current interventions, but more trials (including interprofessional
communication) are needed to be conclusive whether collaborative care is
a key component in perinatal mental healthcare. Funding: None Keywords:
pregnancy, mental disorders, psychosocial, collaborative care