Perinatal depression: RNAO best practice guideline recommends routine screening

New evidence-based recommendations from the Registered Nurses’ Association of Ontario (RNAO) will provide nurses and other health providers with the necessary tools to help those suffering with perinatal depression.

RNAO’s Assessment and Interventions for Perinatal Depression (second edition) best practice guideline (BPG) was released today at a press conference in Toronto. It features 16 recommendations covering a range of topics, including better pre and postpartum care, more co-ordinated supports and greater access to mental health services.

Perinatal depression is a term used to describe depression that can occur during pregnancy or up to one year following childbirth. It is one of the most common mental health illnesses experienced by those who are pregnant or have gone through childbirth. It is estimated that between 10 and 14 per cent of those within that population group in Canada will develop perinatal depression. Despite its prevalence, the condition too often remains undetected and untreated.

Symptoms can include: frequent crying, trouble sleeping, fatigue or low energy levels, changes in appetite, increased anxiety, and difficulties feeling connected to a developing baby or child. Left untreated, symptoms of perinatal depression can be prolonged and in some cases, result in suicide.

Given the risks, the guideline recommends that routine screening be integrated into prenatal and postpartum care. Those diagnosed with the disorder should also have access to psychotherapies such as cognitive behavioural therapy or interpersonal therapy. The BPG also recommends that persons with perinatal depression get access to comprehensive and co-ordinated mental health services that support strategies provided by nurses and other members of the health team.

“It is important to understand that many people suffer through this, not knowing or simply afraid to seek help,” says Dr. Angela Bowen, the guideline panel’s co-chair and professor of nursing at the University of Saskatchewan. “We have to be responsive to the needs of this population and put supports in place to help them cope and ensure their mental health and well-being. This guideline does that.”

Developed using a systematic review of evidence and consultation, the panel was led by Dr. Bowen and Dr. Phyllis Montgomery, a nursing professor at Laurentian University’s School of Nursing in Sudbury. Their work was supported by RNAO's guideline research and development team, which has produced 54 best practice guidelines being implemented in Ontario and around the world.

“Nurses and other health providers play an important role in detecting, treating and referring those who need help for treatment” says Montgomery, adding that “the guideline will be an invaluable resource for health professionals and for the thousands of people who suffer from this type of mental illness.”

Like all RNAO BPGs, Assessment and Intervention for Perinatal Depression (second edition) is based on the most current and relevant evidence and extensive consultation with the expert panel, which included people with lived experience, nurses, and other health professionals with clinical, administrative, and academic expertise. “The rigorous process used to create the guideline ensures the best available evidence is used to develop recommendations that nurses and members of the interprofessional team rely on when providing care,” says RN Katherine Wallace, an implementation manager at RNAO who led the development of the guideline.

RNAO’s CEO Dr. Doris Grinspun – the founder of the association’s BPG program – says the guideline is meant for nurses and all health providers, especially those working in public health, primary care and hospital obstetric units who come in contact with people who are pregnant or who have gone through childbirth. “This can and should be an immensely joyous time for individuals and their families and yet, it can also be a very challenging period. If adopted, the recommendations in our guideline will ensure people are provided with the best possible evidence-based quality care.”

RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the healthcare system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit RNAO.ca or follow us on Facebook and Twitter.

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