Academic journal article Journal of Counseling and Development : JCD

Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

Academic journal article Journal of Counseling and Development : JCD

Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

Article excerpt

Depression is a chronic and recurrent condition that is one of the leading causes of disability for women globally (Murray & Lopez, 1997). Women are two to three times more likely to have depression compared with men, with peak prevalence rates occurring during a woman's child-beating years (American Psychiatric Association [APA], 2000; Halbreich, 2004; Kornstein, 1997). It was once thought that pregnancy provided protection from depression, but epidemiological data have shown comparable rates for pregnant and nonpregnant women (Gavin et al., 2005; Vesga-Lopez et al., 2008). The prevalence rates for major depressive disorder (MDD) in pregnant women range from 7% to 13% (Bennett, Einarson, Taddio, Koren, & Einarson, 2004; Bland, 1997; J. Evans, Heron, Francomb, Oke, & Golding, 2001). However, these rates are almost tripled for certain high-risk groups, including women who are low income, minority status, adolescent, single and living alone, or have a previous history of MDD (Bennett et al., 2004; Da Costa, Larouche, Dritsa, & Brender, 2000; Hobfoll, Ritter, Lavin, Hulsizer, & Cameron, 1995; Pearlstein, 2008; Zayas, Cunningham, McKee, & Jankowski, 2002).

Untreated depression during pregnancy has a number of adverse outcomes not only for the mother but also for her unborn child. Prenatal depression (PND) is associated with poor nutrition and inadequate prenatal medical care as well as alcohol and tobacco use (Halbreich, 2004; Pearlstein, 2008; Van den Bergh, Mulder, Mennes, & Glover, 2005). PND is also related to increased rates of preterm delivery, autonomic anomolies in the fetus, lower birth weight, and complications during delivery (Halbreich, 2004; Pearlstein, 2008). There is also evidence that PND predicts a number of postpartum problems, including maternal depression and cognitive and behavioral complications in the child (Van den Bergh et al., 2005).

Despite the prevalence of PND and its potential adverse outcomes, effective treatment is complicated by three major factors. First, depression is underdetected in pregnant women because its symptoms can mimic common symptoms of pregnancy (e.g., poor sleep, fatigue) and related health conditions (e.g., anemia, gestational diabetes; Moses-Kolko & Roth, 2004; Yonkers, Smith, Gotman, & Belanger, 2009). Second, pregnant women who consider whether or not to continue or start an antidepressant are faced with the vexing decision of weighing the benefits of treating the depression against the risks of possible birth defects and pregnancy complications associated with taking antidepressants (Cohen et al., 2006; Freeman, 2007). Third, although empirically supported psychotherapies have been identified for pregnant women who are depressed (Grote, Zuckoff, Swartz, Bledsoe, & Geibel, 2007; Spinelli & Endicott, 2003), information regarding these treatments is not well disseminated in counseling literature or in training programs, and counselors might not be familiar with these approaches. For example, a search of counseling journals published by the American Counseling Association (ACA) during the past 10 years yielded no articles regarding pregnancy-related counseling issues, including prenatal depression.

Because of this gap in the literature, it is clear that counselors need the training and skills necessary for providing effective counseling for pregnant women. In addition, they need knowledge to skillfully advocate with and on behalf of clients as they make decisions about treatment options (Ratts & Hutchins, 2009). To this end, the purpose of this article is to provide counselors with an overview of best practices for treating women with prenatal depression. First, we discuss issues in screening and diagnosis. Next, we review and discuss the two most common treatments for PND--antidepressants and psychotherapy--in relation to the following published practice guidelines: the Agency for Healthcare Research and Quality's (Gaynes et al. …

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