How Can Medical Assistants Help Address Perinatal Depression in Obstetric Settings?

What you need to know

• Perinatal depression affects up to 1 in 7 pregnant and postpartum individuals, but many do not receive proper screening or treatment.
• Medical assistants and other clinician support staff may be underutilized resources for helping to address perinatal depression in obstetric settings.
• Clinician assistants report having adequate time and interest in addressing depression, while many clinicians feel time-constrained.
• Involving clinician assistants more in depression screening and care could help integrate mental health services into obstetric practices.

The challenge of addressing perinatal depression

Depression is one of the most common complications that can occur during pregnancy and after childbirth. About 1 in 7 pregnant and postpartum individuals experience depression, with even higher rates in some populations. When left untreated, perinatal depression can have serious negative effects on both the birthing parent and child.

Despite how common it is, perinatal depression often goes undiagnosed and untreated. It’s estimated that only about half of cases are identified, and less than 30% of those who screen positive for depression receive treatment. This represents a major gap in care that needs to be addressed.

There are several reasons why perinatal depression is underdiagnosed and undertreated. These include:

• Stigma and misconceptions about mental health issues during pregnancy
• Lack of education about perinatal depression for both patients and providers
• Limited time during obstetric appointments to discuss mental health
• Insufficient training for obstetric providers in managing depression
• Lack of referral options and resources for mental health treatment

To try to improve this situation, there has been a push to better integrate depression screening and treatment into routine obstetric care. However, many obstetric clinicians already feel pressed for time during appointments. This study looked at whether other staff members, particularly clinician assistants like medical assistants, could play a larger role in addressing perinatal depression.

The potential role of clinician assistants

Clinician assistants, which include medical assistants, nursing assistants, and other clinical support staff, are already involved in many aspects of patient care in obstetric settings. They often handle tasks like:

• Rooming patients and taking vital signs
• Administering and scoring health questionnaires and screeners
• Reviewing medication lists
• Taking brief medical histories

This puts clinician assistants in a good position to potentially help with depression screening and follow-up. However, their role in addressing perinatal mental health has not been well studied previously.

What the study examined

This study analyzed data from 12 obstetric practices in Massachusetts to compare the experiences and attitudes of clinicians (doctors, nurse practitioners, midwives) and clinician assistants when it comes to addressing perinatal depression.

The researchers looked at factors like:

• How clinicians and assistants perceived their workplace environment and time constraints
• Attitudes about the importance of addressing depression
• Current practices for depression screening and management
• Confidence in ability to detect and address depression

They wanted to understand if clinician assistants could potentially take on a larger role in integrating depression care into obstetric practices.

Key findings about clinician assistants

The study revealed some interesting findings about clinician assistants and their potential to help with perinatal depression:

Time availability: Nearly 90% of clinician assistants reported having adequate time to complete their work tasks, compared to only about 30% of clinicians. This suggests assistants may have more capacity to take on additional mental health-related responsibilities.

Attitudes: The vast majority (90%) of clinician assistants agreed that addressing depression is an important part of their job. They seem to recognize the significance of perinatal mental health.

Current practices: Only about 30% of assistants reported ever discussing depression with patients. Of those who did, most only brought it up if the patient mentioned it first or said something concerning.

Diversity: Clinician assistants tended to be more racially and ethnically diverse than the clinicians in the study. This could potentially help in connecting with a diverse patient population.

Comparing clinicians and assistants

Some key differences emerged when comparing clinicians to clinician assistants:

Time constraints: Clinicians were much more likely to report not having enough time to complete all their work. However, perception of time adequacy did not seem to affect how often clinicians screened for or discussed depression.

Depression screening: About 89% of clinicians reported consistently screening patients for depression. However, far fewer (around 45%) said they regularly provided depression treatment themselves.

Experience: Clinicians had more years of obstetric experience on average. However, both groups had similar tenure at their current practice, with high turnover rates for assistants.

Potential opportunities

Based on these findings, there may be opportunities to expand the role of clinician assistants in addressing perinatal depression:

Screening: Assistants could take on more responsibility for administering and scoring depression screening questionnaires, given their adequate time and interest.

Education: With proper training, assistants could provide patients with information and resources about perinatal depression.

Follow-up: Assistants may be able to help with scheduling mental health referrals or checking in with patients between appointments.

Brief interventions: Some assistants could potentially be trained in techniques like motivational interviewing to encourage treatment engagement.

Involving assistants more could help integrate depression care into practice workflows without overburdening time-constrained clinicians.

Considerations for implementation

If obstetric practices want to expand the role of clinician assistants in perinatal mental health care, some factors to consider include:

Training needs: Assistants would need proper education on perinatal depression, screening tools, and how to sensitively discuss mental health.

Scope of practice: Any new responsibilities would need to fit within assistants’ legal and regulatory scope of practice.

Workflow integration: Practices would need to thoughtfully integrate assistants’ mental health tasks into existing care processes.

Staff retention: Given high turnover rates, practices may need strategies to improve job satisfaction and retention of clinician assistants.

Cultural competence: The diversity of clinician assistants could be leveraged to provide more culturally responsive mental health care.

Conclusions

• Clinician assistants represent an underutilized resource that could help improve perinatal depression care in obstetric settings.
• Assistants report having adequate time and interest in addressing mental health, while many clinicians feel time-constrained.
• Expanding the role of assistants in depression screening and care could help better integrate mental health services into routine obstetric practice.
• More research is needed on effective ways to involve clinician assistants and the impact on patient outcomes.

Addressing perinatal depression requires a team-based approach. By thoughtfully expanding the roles of clinician assistants, obstetric practices may be able to provide more comprehensive mental health care to pregnant and postpartum patients. This could help close the gap in screening and treatment rates for this common and serious condition.