Development of Practice Guidelines for Peripartum Depression in Primary Healthcare

Abstract

Background: Peripartum depression significantly impacts maternal health but often goes undiagnosed and untreated. Objective: This study aims to develop practice guidelines for addressing peripartum depression in Primary Healthcare (PHC) settings in Egypt. Methods: A qualitative study was conducted from October 2020 to August 2021. The Delphi technique was employed, engaging 13 experts in psychiatry and family medicine from Egyptian universities, the Ministry of Health and Population, WHO, and the World Organization of Family Doctors. Three email-based Delphi rounds were conducted. Results: Key recommendations included: 1) Prevention: Health education on exercise, telephone peer support for antenatal depression, and family therapy for postpartum depression. 2) Screening: Use the Patient Health Questionnaire II every trimester for pregnant women and the Edinburgh Postpartum Depression Scale at well-child visits during the first postpartum year. 3) Diagnosis: Employ the Beck Depression Inventory II for antenatal depression and the Postpartum Depression Screening Scale for postnatal cases. 4) Treatment: Cognitive Behavioral Therapy (CBT) for mild cases; CBT with sertraline (half-dose for antenatal, full-dose for postnatal) for moderate cases; no hormonal therapy for postpartum depression. 5) Referral: For severe cases, comorbidities, suicidal thoughts, psychosis, or substance abuse. Conclusion: These guidelines should be implemented across PHC facilities in Egypt with comprehensive training for family physicians to ensure effective application.