Peer-Delivered Psychotherapy for Postpartum Depression: Has Its Time Come? Not Yet—Reply to Tomfohr-Madsen et al

J Clin Psychiatry 2022;83(3):21lr14366a

To cite: O’Hara MW. Peer-delivered psychotherapy for postpartum depression: has its time come? not yet—reply to Tomfohr-Madsen et al. J Clin Psychiatry. 2022;83(3):21lr14366a.
To share: https://doi.org/10.4088/JCP.21lr14366a

© Copyright 2022 Physicians Postgraduate Press, Inc.

^aUniversity of Iowa, Iowa City, Iowa
*Corresponding author: Michael W. O’Hara, PhD, University of Iowa, 340 Iowa Ave, Iowa City, IA 52242 ([email protected]).

See letter by Tomfohr-Madsen et al and commentary by O’Hara

To the Editor: Tomfohr-Madsen and colleagues¹ provide a spirited defense of peer-led psychotherapy in their response to my recent commentary² in this journal regarding the Amani et al³ report. Their response is centered on a deep distrust of the current mental health system, one in which they play an integral role. It is fair to say that there are inadequacies in the mental health systems of developed countries and that new approaches are needed to overcome barriers that many pregnant and postpartum women face in accessing care. As I made clear in my commentary, I see an important role for peers (women who have experienced perinatal depression or anxiety) in providing support to depressed pregnant and postpartum women. My main point of dispute is whether there is enough evidence to begin a systematic process of training former sufferers as the principal mental health providers for women suffering from perinatal depression and anxiety.

The recent review by Singla et al⁴ of the effectiveness of nonspecialist-delivered interventions for perinatal mental health in high-income countries included 15 trials of counseling interventions for treatment of depression, only 1 of which included peers who had experienced a perinatal depression as treatment providers. The rest of the trials used nurses, midwives, health visitors, and in one case women from the community as treatment providers. In sum, even Singla and colleagues’ very strong review of the literature on the care of postpartum depression by nonspecialists suggests that there is evidence of treatment efficacy for health workers who are trained to deliver brief mental health interventions but very little evidence for peers who have suffered from perinatal depression. In closing, I want to reiterate my commitment to the care of women suffering from perinatal depression, a commitment that spans over 40 years.

Published online: April 27, 2022.
Potential conflicts of interest: None.
Funding/support: None.