Social Work Interventions Can Improve Perinatal Mental Health: A Systematized Review

Background: Mental health conditions during the perinatal period (from pregnancy through 12 months postpartum), are a leading cause of maternal mortality in the United States (U.S.). Nationally, 15% of women experience depression during pregnancy while 12% experience postpartum depression. These rates are higher for women previously diagnosed with mental health or substance use disorders or a history of trauma. Social risk factors such as stress, food insecurity and lack of social support are also associated with maternal mortality. Social workers are uniquely qualified to address both mental health and social needs of perinatal women and are often key members on interprofessional health teams. However, current literature lacks a comprehensive review of perinatal mental health interventions delivered by social workers.

Methods: The purpose of this systematized review was to answer the following questions: 1) What healthcare settings have integrated social workers into perinatal mental health interventions?; 2) What perinatal interventions are social workers utilizing?; 3) What mental health outcomes are being measured?; and 4) Are social work interventions efficacious for perinatal mental health needs?

We searched literature from the following databases: Pubmed, Web of Science, CINAHL, SocINDEX, and PsychInfo. Inclusion criteria were: a perinatal mental health and/or substance use intervention; inclusion of a social worker within intervention; at least one mental health outcome including screening/referral rates; pregnant and/or postpartum participants; within a U.S. healthcare setting; and published after 2008. 1509 articles were initially identified. After de-duplication, 1260 titles and abstracts were reviewed for inclusion in the full-text review. Out of the 60 full-text articles reviewed, 17 met inclusion criteria. Additionally, we conducted a backward hand search and identified an additional 5 papers, for a final sample of 22.

Results: Most studies were either non-randomized, quantitative studies (46%) or randomized control trials (36%) with only a handful of cross-sectional (14%) or mixed methods studies (5%). Social workers were embedded in a variety of settings including OBGYN offices (40%), other outpatient clinics like primary care (14%), hospitals (18%) and community settings like home visitation programs (27%). Social workers conducted screening and referral for mental health conditions, behavioral health interventions, case management, care coordination and psychoeducation. Social workers who conducted behavioral health interventions primarily utilized interpersonal psychotherapy (63%) and problem solving therapy (38%) with two studies not specifying a psychotherapeutic modality. Studies reported mental health outcomes such as depression (55%), healthcare utilization (32%) and process outcomes associated with mental health screening and referral (64%). Most intervention studies (73%) reported at least one significant improvement in a mental health outcome associated with a social work intervention.

Conclusions: Efficacious perinatal mental health interventions are necessary for the improvement of maternal health outcomes. Social workers play a key role within integrated behavioral health initiatives and our findings suggest that interventions delivered by social workers improve perinatal mental health outcomes. However, there was considerable variation across studies in terms of study type, intervention type and outcomes. Future research is needed to optimize the implementation of these social work interventions through comparative effectiveness studies.