Clinical practice guidelines play a crucial role in evidence-based practice, providing recommendations based on a systematic review of evidence to optimize patient care. In the perinatal period, guidelines have been instrumental in improving outcomes for women with mental health difficulties. For example, recent research has shown that access to community perinatal mental health teams can reduce the risk of relapse in women with severe mental illness postpartum.
Clinical practice guidelines for the perinatal period are even more important now that community perinatal mental health teams are being rolled out across the UK.
Methods
The review followed established methodological guidelines for systematic reviews of clinical practice guidelines and utilized the PRISMA checklist. A systematic search was conducted to identify guidelines published between 2012 and 2022 that focused on psychological assessment and intervention in the perinatal period. Data were extracted, and a narrative synthesis was performed to compare and analyze the guidelines.
Results
Summary and Quality of Guidelines
Seven guidelines were included in the review, with varying levels of quality and coverage across target populations and stages of assessment and intervention. Notably, the COPE guideline received the highest quality rating.
Themes from Guidelines
- Specific therapeutic approaches in the perinatal context
- Equitable care considerations
- Individual and systemic factors
Comparisons between Guidelines
While recommendations differed, key themes such as therapeutic approaches and equitable care considerations were consistent across guidelines.
COPE guidelines, used in Australia, were rated as the highest quality (99%).
Conclusions
The review highlighted the consistency in key recommendations across guidelines but noted variations in quality and scope. Guidelines should aim to include recommendations for diverse populations and contexts within the perinatal period.
The content of key recommendations was consistent across perinatal mental health guidelines.
Implications for Practice
Guideline developers should prioritize evidence-based recommendations and consider the needs of diverse populations in the perinatal period. Clinicians should be aware of and adhere to established guidelines to ensure high-quality care.
This review only covers guidelines written in English.
Strengths and Limitations
The review provides a comprehensive overview of existing guidelines in the field but is limited by its focus on English-language guidelines. Future research should aim to incorporate guidelines from diverse cultural backgrounds.
This review of clinical practice guidelines will be useful for busy NHS clinicians.
Statement of Interests
None.
Links
Primary Paper
O’Brien, J., Gregg, L., & Wittkowski, A. (2023). A systematic review of clinical psychological guidance for perinatal mental health. BMC psychiatry, 23(1), 790.
Other References
Gurol-Urganci, I., Langham, J., Tassie, E., Heslin, M., Byford, S., Davey, A., & O’Mahen, H. A. (2024). Community perinatal mental health teams and associations with perinatal mental health and obstetric and neonatal outcomes in pregnant women with a history of secondary mental health care in England: a national population-based cohort study. The Lancet Psychiatry, 11(3), 174-182.
Howard, L. M., Megnin-Viggars, O., Symington, I., & Pilling, S. (2014). Antenatal and postnatal mental health: summary of updated NICE guidance. Bmj, 349.
Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Graham, R., Mancher, M., Miller Wolman, D., Greenfield, S., & Steinberg, E. (Eds.). (2011). Clinical Practice Guidelines We Can Trust. National Academies Press (US).
NHS England. (2016). NHS England kickstarts programme to help 30,000 more new or expectant mums with serious mental illness.
