Pregnancy and the first year postpartum – referred to as the peripartum period – are a period of tremendous physiological, psychological, and social changes in a woman’s life. An estimated 1 in 5 women develop mental health problems during the peripartum period, with depression and anxiety being the most prevalent mental health problems. Only half of these women will ever receive a diagnosis, and even less will be fortunate enough to receive treatment.
Over the last four years, the Riseup-PPD COST Action has been working to advance research, practice, and foster collaborative work within Europe and beyond to improve understanding and treatment of peripartum depression (PPD). Their latest and final action output is the production of evidence-based clinical practice guidelines to address peripartum depression.
Peripartum depression adversely affects not only the mother and her overall health but also the infant’s health and development and the wider family relationships. Furthermore, it puts a strong socio-economic burden on society as a whole. In order to prevent peripartum depression and offer timely screening followed by appropriate treatment, it is crucial to have evidence-based clinical practice guidelines to instruct on all these steps.
Professor Ana Ganha Avila, the chair of Riseup-PPD, said: “These guidelines provide a roadmap for healthcare professionals, women, men, families, health managers, and policymakers, fostering a lasting impact on clinical practice and mental health policies in Europe. By equipping future clinical practice with a strong foundation, the guidelines ensure that the action’s influence continues long after its formal conclusion, benefiting countless individuals and the forthcoming generations.”
In fact, many European countries do not have any clinical practice guidelines for PPD in place, and in countries where they exist, discrepancies in recommendations and the low methodological quality of the guidelines can lead to disparities and inequalities in clinical management. Riseup-PPD developed their guidelines using the WHO Handbook for Guideline Development to ensure that the recommendations can effectively function as an evidence-based handbook for all involved.
Mariana Moura Ramos, a member of Riseup-PPD and Guideline Development Group Leader, said: “Developing these guidelines was based on a systematic evaluation of the existing and high-quality scientific evidence. This means that now all healthcare professionals who take clinical care of peripartum women are equipped with up-to-date information about the best PPD prevention, screening, and treatment alternatives and can discuss with their patients which are the more suitable options for their specific situation, considering their values and preferences.”
In all, there are 44 recommendations divided over three sections (prevention, screening, and treatment). The interventions are broken down to encompass a wide range of strategies, including biological interventions such as pharmacotherapy, non-invasive brain stimulation, psychological and psychosocial interventions, and other non-conventional and complementary interventions. This approach helps provide different pathways for managing PPD and provides evidence on the benefits, harms, and efficacy of interventions like electroconvulsive therapy (ECT), yoga, Chinese herbs, transcranial direct current stimulation (tDCS), and antidepressants.
“Four million babies are born every year in Europe. That’s four million opportunities to make a change. We can go together towards this change and put our expertise available to you all,” said Sandra Nakic Rados, the vice chair of Riseup-PPD and Guidelines Development Group co-leader.
On 7th November 2023, the guidelines were launched at a dedicated event at the European Parliament with Make Mothers Matter, hosted by MEP Maria Noichl with the input of MEP Radka Maxová. The event included a call to action for all policymakers and the wider European community by Riseup-PPD to make maternal mental health a priority, make mental healthcare accessible to all women, and to develop new policies for peripartum depression that incorporate the Riseup-PPD Guidelines.
Maria Noichl, a member of the European Parliament, said: “We need a ‘Care Deal’ for Europe at the same level of the ‘Green Deal’. This goes beyond caring for older people, and we should have more vision around birth. These guidelines must be a clear position in the ‘Care Deal’ and we should always have this in our focus.”
Radka Maxova, another member of the European Parliament, added: “I think now is the right time to promote this topic to the mandate of the new European Parliament. Maternal mental health should be, it must be, the number one priority.”