title: Strategies for improving perinatal depression treatment in North American outpatient obstetric settings.
abstract: OBJECTIVE
  To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment.
  
  
  METHODS
  Eighty-four MEDLINE/PubMed searches were conducted using the terms perinatal depression, postpartum depression, antenatal depression, and prenatal depression in association with 21 other terms. Of 7768 papers yielded in the search, we identified 49 papers on barriers and facilitators, and 17 papers on interventions in obstetric settings aimed to engage women and/or providers in treatment.
  
  
  RESULTS
  Barriers include stigma, lack of obstetric provider training, lack of resources and limited access to mental health treatment. Facilitators include validating and empowering women during interactions with health care providers, obstetric provider and staff training, standardized screening and referral processes, and improved mental health resources.
  
  
  CONCLUSIONS
  Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.
authors.affiliation: Department of Psychiatry and Ob/Gyn, UMass Medical School, Worcester, MA 01655, USA. nancy.byatt@umassmemorial.org
authors.forename: Nancy
authors.initials: N
authors.lastname: Byatt
authors.forename: Tiffany A Moore
authors.initials: TA
authors.lastname: Simas
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lundquist
authors.forename: Julia V
authors.initials: JV
authors.lastname: Johnson
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Ziedonis
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D019052:Depression, Postpartum / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology*; D009656:North America; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000458:organization & administration*; D011181:Postnatal Care / Q000458:organization & administration; D011247:Pregnancy; D011369:Professional-Patient Relations; D058996:Quality Improvement; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration; D055815:Young Adult