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Fresh Perspectives in Perinatal Depression Research: Psychosocial Interventions and Mental Health Services

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Meeting Summary
Rockville, Maryland

Sponsored by:
National Institute of Mental Health
Division of Services and Intervention Research (DSIR)
Office for Research on Disparities and Global Mental Health (ORDGMH)
National Institutes of Health
NIH Office of Research on Women’s Health (ORWH)

On October 5-6, 2010, the NIMH Division of Services and Intervention Research (DSIR) convened a workshop to provide the growing number of early-stage perinatal depression psychosocial intervention and services investigators with the opportunity to discuss research strategies consistent with public health needs and NIMH priorities. NIMH priorities for perinatal depression align with current developments in federal healthcare legislation concerning the mental health of pregnant and post-partum women. Research priorities also address calls for comparative effectiveness research and personalized intervention approaches; emerging developments in novel research diagnostic criteria; and, implementation of the NIMH Strategic Plan and the National Advisory Mental Health Council Work Group Report, “From Discovery to Cure: Accelerating the Development of New and Personalized Interventions.” The workshop provided a forum for perinatal depression investigators, along with NIMH and NIH staff, to review and discuss current psychosocial services and intervention research. With input from the Centers for Disease Control and Prevention and experts from the broader field of depression research, the workshop incorporated informative viewpoints from outside the immediate field of perinatal mental health. Plenary presentations, large group discussions, and smaller breakout group sessions facilitated the exchange of ideas about findings from current research, challenges and limitations of current work, as well as fresh perspectives to bring to bear on next steps in perinatal depression research.

To begin the workshop, David Chambers, D. Phil., Chief of the DSIR Services Research and Clinical Epidemiology Branch, welcomed attendees and introduced presentations by NIMH Director Thomas Insel, MD, and ORDGMH Director Pamela Collins, MD, MPH. Dr. Insel discussed NIMH interest in better understanding the pathophysiology of mental illness, in order to support the development of interventions that are both pre-emptive and personalized. He also spoke about the importance of investigators working more collaboratively by utilizing standardized measures and sharing data. Dr. Collins encouraged attendees to consider mental health in global terms, to see linkages between research conducted in low- and middle-income countries and research conducted in the United States; and to consider learning opportunities arising from a bidirectional exchange of knowledge and ideas.

The opening plenary session included talks on epidemiology, genetics and biomarkers, child mental health outcomes, and a presentation on issues to consider regarding the adaptation of existing interventions to specific populations or healthcare settings. After the plenary session, workshop participants discussed current issues in perinatal depression services and psychosocial interventions research in small, interactive breakout groups. The second day of the workshop involved presentations and plenary discussion oriented toward identifying fresh perspectives with regard to research questions, research design and methodology, and the provision of mental health interventions in communities with limited resources. The discussion from the plenary sessions and the breakout groups yielded numerous themes of interest to investigators in the field, as well as to NIMH.

Themes of interest included but were not limited to:

  • Empirically evaluating whether perinatal depression is a distinct subtype of depression, which therefore might have a different pathophysiology or require unique adaptations of interventions;
  • Providing psychosocial researchers with support and guidance about how to theoretically and practically incorporate biological data into psychosocial research;
  • Providing empirically supported arguments to justify adapting interventions for specified subgroups, including: women belonging to various racial and ethnic minority groups, age groups, or income levels; individuals with various co-morbid conditions or factors (e.g., post-traumatic stress disorder, interpersonal violence); or, individuals receiving care in specified settings (e.g., obstetric practices, home visitation, and pediatric practices);
  • Developing and encouraging the use of research infrastructures (networks, funding mechanisms, consortia) to support work integrating child outcomes into perinatal depression treatment research, and integrating the pathophysiology of perinatal depression into psychosocial research;
  • Addressing the strengths and limitations of current perinatal depression assessment tools;
  • Debating the utility and consequences of screening for perinatal depression, particularly when depression care resources are scarce, along with questions about when to screen, who to screen, who should screen, and with what tools;
  • Enhancing women’s access to services, the acceptability of those services, as well as providers’ capacity to deliver appropriate, effective, and sustainable interventions; these issues arise particularly for interventions and services for lower-income women, for whom multiple barriers to treatment can interfere with treatment engagement and retention;
  • Standardizing assessment methodologies to advance data and knowledge sharing;
  • Considering potential roles for paraprofessionals in the delivery of perinatal depression care, in light of the available workforce and successful experiences with paraprofessionals in certain circumstances; and,
  • Developing research approaches that are efficient in cost and design; are powerful enough to accommodate adaptive designs, comparative effectiveness, and stepped-care models; and address mediator, moderator and mechanism questions, ultimately leading to more cost-effective, personalized interventions.

For more information, please contact Lauren Hill, PhD, hillla@mail.nih.gov, 301-443-2638.