Evaluating the clinical effectiveness of a specialized perinatal psychiatry inpatient unit

Abstract

Women experiencing severe perinatal mental illness during pregnancy or postpartum have unique needs when psychiatric hospitalization is indicated. Although many countries have established mother-baby psychiatric units, similar facilities have not been available in the US. In 2011, the University of North Carolina at Chapel Hill inaugurated the first Perinatal Psychiatry Inpatient Unit (PPIU) in the US. We describe the unique characteristics of the patient population and report clinical outcomes guiding development and refinement of treatment protocols. Ninety-two perinatal patients were admitted between September 2011 and September 2012, and 91 completed self-report measures at admission and discharge. Perinatal unipolar mood disorder was the most frequent primary diagnosis (60.43%), and eleven patients (12%) were admitted with psychosis. The data document clinically and statistically significant improvements in symptoms of depression, anxiety and active suicidal ideation between admission and discharge (p < .0001), as assessed by the Edinburgh Postnatal Depression Scale, Patient Health Questionnaire, and Generalized Anxiety Disorder Scale. Overall functioning was also improved, demonstrated by a significant mean difference of −10.96 in total scores of the Work and Social Adjustment Scale (p < 0.0001). Data suggest that delivering specialized and targeted interventions for severe maternal mental illness in a safe and supportive setting produces positive patient outcomes.

Is Postpartum Depression a Distinct Disorder?

“…The therapeutic needs of women with PPD also differ from those of women with depression at other times and often require a multidisciplinary approach [28,34]. For example, physicians need to consider the implications of psychotropic medications during breastfeeding and to acknowledge and treat the mother in the context of the dyadic relationship with the baby.…”

A systematic review of research on psychiatric mother-baby units

“…Mean length of stay ranged from 6.93 days in a study in the US (Meltzer-Brody et al 2014) to 11.6 weeks in a study in Israel (Maizel et al 2005). These differences are likely to be, at least in part, due to the different nature and purpose of MBUs in different countries and regions.…”

“…The study found that the women experienced returning home from the MBU as a significant life event, and that women did not feel they had clear enough support plans post-discharge. Meltzer-Brody et al 2014 note that additional studies need to address the transition from inpatient to community care. Howard et al (2003) use data from 1,255 mothers on the Marcé data base in 2001 to ascertain levels of continued social service supervision after discharge, noting that mothers with schizophrenia show a high risk of supervision and recommending that the whole family context should be treated.…”

Management of perinatal depression with non-drug interventions

“…Women with severe perinatal mental illness may need to be admitted to hospital to achieve stability in a safe environment. Specialized perinatal units have been an important treatment option for women in other nations for many years,144145 and they are now being offered in the US 146147. Established across countries in Europe, psychiatric mother-baby units allow for infants to remain on the psychiatric unit with their mother 24 hours a day 144145.…”

“…Established across countries in Europe, psychiatric mother-baby units allow for infants to remain on the psychiatric unit with their mother 24 hours a day 144145. Such units have not been possible in the US owing to the healthcare system that does not support neonatal or pediatric care in the psychiatry unit; however, specialized perinatal units have been established that allow for infants to be on the unit for extended hours during the day 147. These inpatient perinatal units offer specialized care with particular attention to maternal-infant attachment.…”