GPs ‘very useful part’ of support network for postnatal depression

Morgan Liotta

26/03/2020 11:12:04 AM

In the fourth of a series of HANDI updates, newsGP talks to the author of a recently added intervention.

Woman sitting on bed
GPs have a significant role in helping to identify a patient’s risk of postnatal depression through shared maternity care.

The RACGP’s Handbook of Non-Drug Interventions (HANDI) aims to provide GPs with free, up-to-date evidence-based interventions that do not rely on prescribing medicine. HANDI also offers resources to assist in patient decision-making.
Recent updates and new HANDI entries add to the suite of 65 interventions, with more in development and planned to be released on the site over the coming year.
Associate Professor of General Practice at the University of Tasmania’s School of Medicine, Jan Radford, is lead author of the recently added intervention, ‘Psychological treatments for postnatal depression’.
She values this as a useful resource to support women experiencing mental health issues following the birth of their baby.
‘HANDI succinctly presents the current evidence for effective care of someone with postnatal depression, with tips on care and resources to share with your patient as both of you explore her options for care,’ she told newsGP
‘You remain her coach as she tries various approaches to conquering her postnatal depression. 
‘A GP who remains engaged in following their patient’s progress will be a very useful part of her support network – the GP’s support can be therapeutic with visits designed to monitor progress so that deepening depression can be identified and addressed.’ 
To identify postnatal depression, HANDI uses the Edinburgh scale score >12 or Beck Depression Inventory score ≥ 10.
Around 13% of mothers experience postnatal depression in the first year after childbirth. If left untreated, it can negatively affect mother–child bonding, shorten breastfeeding duration, lead to marital difficulties and increase the risk of future depression.
Interventions such as cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and counselling may be provided by trained GPs or other clinicians such as psychologists, HANDI says, and GPs should be familiar with the areas of expertise of their local network to ensure appropriate referrals.
Associate Professor Radford believes GPs have a significant role in helping to identify a patient’s risk of postnatal depression, through shared maternity care.
‘GPs ideally should provide antenatal and postnatal care of their female patients – these visits present opportunities to look for antenatal depression which is a risk factor for postnatal depression,’ she said.
‘Those GPs offering care throughout a pregnancy are in an even better situation to monitor their patients for postnatal depression.
‘Asking about anxiety and low mood is the best course of action, otherwise use of a tool such as the Edinburgh scale may assist in screening.’

The HANDI entry highlights some challenges that may present during psychological interventions in the instance of women experiencing antenatal or postnatal depression or anxiety, and how best to overcome these.
Explaining that postnatal depression is common and manageable, challenging unhelpful or unrealistic expectations the patient may have, and arranging consultations so that partners are also present, are all useful approaches.
HANDI also lists that sharing experiences with other women with postnatal depression in moderated meetings can provide ‘uniquely powerful social and emotional support’.
Associate Professor Radford said this is particularly important given the common challenges in patients experiencing postnatal depression.
‘Challenges include a limited support network available to your patient such as little family support, [or] no new mother’s group in her area,’ she said.
Associate Professor Radford is hoping the HANDI intervention can assist GPs with these challenges and better support their patients.
‘[It is important for] GPs to feel confident to offer psychoeducation and help with problem solving regarding exercise, or lack of access to CBT or IPT skills in the clinical psychological support network available.’
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antenatal care HANDI non-drug interventions postnatal depression

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