Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination

Abstract

BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members ( n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic’s experience serves as a role model for other centers to replicate this successful integrated model of care.

Psychological and Physical Intimate Partner Aggression Are Associated with Broad and Specific Internalizing Symptoms during Pregnancy

“…Interventions that focus on enhancing communication and conflict management skills as a couple during pregnancy, such as the Family Foundations Program [71], have the potential to reduce IPV and parental psychopathology, strengthen the couple relationship and promote resiliency, and ultimately improve child outcomes. Further, given that women and their partners engage with the healthcare system more regularly across the prenatal period, models of integrated perinatal care may be particularly beneficial for addressing IPV and associated psychopathology by increasing access to care and providing more timely services [72,73]. In addition, efforts to address paternal perinatal mental health are critical for maternal well-being, as untreated psychopathology may interfere with fathers' ability to support their partners across pregnancy and the transition to parenthood [28].…”