Clinical characteristics of perinatal psychiatric patients: a chart review study

A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness

There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs.

A 5 years' experience of a parent-baby day unit: impact on baby's development

Introduction

Psychiatric Mother-Baby Units are well established in France, United Kingdom, and Australia, mostly in full-time hospitalization. Inpatient units are considered as best practice for improving outcomes for mothers and babies when the mother is experiencing severe mental illness and many studies have showed the effectiveness of care for the mother or the mother-infant relationship. Only a limited number of studies have focused on the day care setting or on the development of the baby. Our parent-baby day unit is the first day care unit in child psychiatry in Belgium. It offers specialized evaluation and therapeutic interventions focused on the baby and involves parents with mild or moderate psychiatric symptoms. The advantages of day care unit is to reduce the rupture with social and family living.

Aims

The objective of this study is to evaluate the effectiveness of parent-baby day unit in prevention of babies' developmental problems. First, we present the clinical characteristics of the population treated in the day-unit in comparison to the features presented in the literature review about mother-baby units, which usually receive full-time treatment. Then, we will identify the factors that might contribute to a positive evolution of the baby's development.

Materials and methods

In this study, we retrospectively analyze data of patients admitted between 2015 and 2020 in the day unit. Upon admission, the 3 pillars of perinatal care - babies, parents, and dyadic relationships - have systematically been investigated. All the families have received a standard perinatal medico-psycho-social anamnesis, including data on the pregnancy period. In this unit, all the babies are assessed at entry and at discharge using the diagnostic 0 to 5 scale, a clinical withdrawal risk, and a developmental assessment (Bayley). Parental psychopathology is assessed with the DSM5 diagnostic scale and the Edinburgh scale for depression. Parent-child interactions are categorized according to Axis II of the 0 to 5 scale. We have evaluated the improvement of children symptomatology, the child development and the mother-child relation between the entrance (T1) and the discharge (T2) and we have compared two groups of clinical situations: a group of patients with a successful evolution (considering baby's development and the alliance with the parents) and a group of unsuccessful evolution during hospitalization.

Statistical analysis

We use descriptive statistics to characterize our population. To compare the different groups of our cohort, we use the T-test and non-parametric tests for continue variables. For discrete variables, we used the Chi² test of Pearson.

Discussion

The clinical population of the day unit is comparable to the mother-baby units in terms of psychosocial fragility but the psychopathological profile of the parents entering the day unit shows more anxiety disorder and less post-partum psychosis. The babies' development quotient is in the average range at T1 and is maintained at T2. In the day unit, the number of symptoms as well as the relational withdrawal of the babies is reduced between T1 and T2. The quality of parent-child relationship is improved between T1 and T2. The children of the group of pejorative evolution had a lower developmental quotient at the T1 and an overrepresentation of traumatic life events.

Conclusion

These results indicate that parent-baby day unit lead to positive outcomes in clinical situations with anxio-depressive parents, relational withdrawal of the babies, functional problems of the babies but not when a significant impact on the development of the baby already exists. The results of this study can guide therapeutic approaches for the benefit of care in parent-baby day units, and improve the development of the child and of the dyadic relationships.

Preventing maternal mental health disorders in the context of poverty: pilot efficacy of a dyadic intervention

BACKGROUND

The United States Preventive Services Task Force recommends that clinicians provide or refer pregnant and postpartum women who are at an increased risk of perinatal depression to counseling interventions. However, this prevention goal requires effective interventions that reach women at risk of, but before, the development of a depressive disorder.

OBJECTIVE

We describe a pilot efficacy trial of a novel dyadic intervention to prevent common maternal mental health disorders, that is, Practical Resources for Effective Postpartum Parenting, in a sample of women at risk of maternal mental health disorders based on poverty status. We hypothesized that Practical Resources for Effective Postpartum Parenting compared with enhanced treatment as usual would reduce symptoms of maternal mental health disorders after birth.

STUDY DESIGN

A total of 60 pregnant women who were recruited from obstetrical practices at Columbia University Irving Medical Center were randomized to the Practical Resources for Effective Postpartum Parenting (n=30) or enhanced treatment as usual (n=30) intervention. The Edinburgh Postnatal Depression Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Patient Health Questionnaire were used to compare maternal mood at 6 weeks, 10 weeks, and 16 weeks after delivery.

RESULTS

At 6 weeks after delivery, women randomized to Practical Resources for Effective Postpartum Parenting had lower mean Edinburgh Postnatal Depression scores (P=.018), lower mean Hamilton Depression scores (P<.001), and lower mean Hamilton Anxiety scores (P=.041); however, the incidence of postpartum mental disorders did not differ by treatment group.

CONCLUSION

The Practical Resources for Effective Postpartum Parenting, which is an intervention integrated within obstetrical care, improves subclinical symptomology for at-risk dyads at a crucial time in the early postpartum period; however, our study did not detect reductions in the incidence of postpartum mental disorders.

Pregnancy and postpartum antidepressant use moderates the effects of sleep on depression

This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during pregnancy. Women (N = 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.

The Roles of Maternal Depression, Serotonin Reuptake Inhibitor Treatment, and Concomitant Benzodiazepine Use on Infant Neurobehavioral Functioning Over the First Postnatal Month

OBJECTIVE

The purpose of this article was to systematically compare the developmental trajectory of neurobehavior over the first postnatal month for infants with prenatal exposure to pharmacologically untreated maternal depression, selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors (collectively: SSRIs), SSRIs with concomitant benzodiazepines (SSRI plus benzodiazepine), and no maternal depression or drug treatment (no exposure).

METHOD

Women (N=184) were assessed at two prenatal time points to determine psychiatric diagnoses, symptom severity, and prenatal medication usage. Infants were examined with a structured neurobehavioral assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) at multiple time points across the first postnatal month. SSRI exposure was confirmed in a subset of participants with plasma SSRI levels. General linear-mixed models were used to examine group differences in neurobehavioral scores over time with adjustment for demographic variables and depression severity.

RESULTS

Infants in the SSRI and SSRI plus benzodiazepine groups had lower motor scores and more CNS stress signs across the first postnatal month, as well as lower self-regulation and higher arousal at day 14. Infants in the depression group had low arousal throughout the newborn period. Infants in all three clinical groups had a widening gap in scores from the no-exposure group at day 30 in their response to visual and auditory stimuli while asleep and awake. Infants in the SSRI plus benzodiazepine group had the least favorable scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale.

CONCLUSIONS

Neonatal adaptation syndrome was not limited to the first 2 weeks postbirth. The profile of neurobehavioral development was different for SSRI exposure than depression alone. Concomitant benzodiazepine use may exacerbate adverse behavioral effects.

Symptoms of the anxiety disorders in a perinatal psychiatric sample: a chart review

Symptoms of anxiety are a central feature of perinatal mental health, yet the anxiety disorders have received considerably less attention than depression in both perinatal research and practice. The present investigation involved a retrospective review of the clinical records of 334 patients seen at a psychiatric day hospital program serving pregnant and postpartum women. We examined the frequency with which the patients in this setting reported symptoms of anxiety, clinical correlates of elevated anxiety, and patterns of diagnosis in the clinical record. The results suggest that anxiety symptoms are very common in this population and that the presence of anxiety is associated with a more severe clinical profile, including higher rates of suicidality and increased use of psychotropic medications during pregnancy and postpartum. Although anxiety symptom levels were markedly elevated in this sample, anxiety disorders were diagnosed at relatively low rates. Implications for clinical practice, including discharge and treatment planning, are discussed.

A mother-baby psychiatric day hospital: History, rationale, and why perinatal mental health is important for obstetric medicine

BACKGROUND

Women frequently experience depression, anxiety, or other mental health concerns during pregnancy and postpartum, impacting her and her infant's health. Patients who require management of medical conditions during the perinatal period are even more likely to experience depression and anxiety compared to those without comorbid medical issues. Despite the availability of effective treatments, perinatal mental health utilization rates are strikingly low.

METHODS

To address common treatment barriers, we developed a specialized mother-baby day hospital for women with psychiatric distress during the peripartum. In this report, we summarize findings from 800 patient satisfaction surveys collected from women treated at the program between 2007 and 2012.

RESULTS

Findings suggest that women are highly satisfied with the treatment received, often noting that the inclusion of the baby in their treatment is a highly valued feature of care.

CONCLUSION

The relevance of perinatal mental health services for patients who are followed by obstetrical medicine specialists is discussed.

Screening and pathways to maternal mental health care in a South African antenatal setting

In low-resource settings, a stepped care approach is necessary to screen and provide care for pregnant women with mental health problems. This study sought to identify screening items that were most robust at differentiating women experiencing psychological distress and requiring counselling [assessed by screening with the Edinburgh Postnatal Depression Scale (EPDS) and a Risk Factor Assessment (RFA)] from those with a psychiatric disorder as diagnosed by a psychiatrist. Case records of women in an antenatal mental health service in Cape Town were reviewed. Composite scores and individual items on screening scales (EPDS, RFA) of participants who qualified for counselling (n = 308) were compared to those of participants who were diagnosed with a psychiatric disorder (n = 58). All participants with a psychiatric disorder were diagnosed with either depression or anxiety disorders. These participants had higher mean scores on the EPDS and RFA than those who qualified for counselling (p < 0.01). Logistic regression and ROC analyses suggested that the best items to distinguish women with depression or anxiety from those qualifying for counselling were 'I have felt sad and miserable', 'I am not pleased about being pregnant' and 'I have had serious depression, panic attacks or problems with anxiety before' (sensitivity 0.655, specificity 0.750 for this combination of three items). A small number of items may be useful in screening for mental illness in pregnancy which requires higher levels of care. Such screening may contribute to a more efficient stepped care approach.

Research strategies that result in optimal data collection from the patient medical record

Data obtained from the patient medical record are often a component of clinical research led by nurse investigators. The rigor of the data collection methods correlates to the reliability of the data and, ultimately, the analytical outcome of the study. Research strategies for reliable data collection from the patient medical record include the development of a precise data collection tool, the use of a coding manual, and ongoing communication with research staff.

Breastfeeding among women exposed to antidepressants during pregnancy

This prospective cohort study compares the breastfeeding outcomes of women exposed to selective serotonin reuptake inhibitor (SSRI) antidepressants at the time of delivery, those who discontinued use prior to delivery, and those not exposed. Participants include 466 pregnant women who enrolled in the California Teratogen Information Service Clinical Research Program (CTIS) over 10 years. In bivariate analyses, breastfeeding rates were significantly different across SSRI exposure groups, with unexposed women having the highest rates. We used logistic regression to examine the relationship between SSRI exposure and breastfeeding outcomes. After adjustment for potential confounders, those exposed to an SSRI both prior to delivery (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.20-0.94) and at the time of delivery (OR, 0.34; 95% CI, 0.16-0.72) were significantly less likely to initiate breastfeeding as compared to unexposed women. Women exposed to an SSRI during pregnancy appear to be at risk for poorer breastfeeding outcomes and may benefit from additional education and support.

Newborn neurobehavioral patterns are differentially related to prenatal maternal major depressive disorder and serotonin reuptake inhibitor treatment

BACKGROUND

Prenatal serotonin reuptake inhibitor (SRI) exposure has been related to adverse newborn neurobehavioral outcomes; however, these effects have not been compared to those that may arise from prenatal exposure to maternal major depressive disorder (MDD) without SRI treatment. This study examined potential effects of MDD with and without SRI treatment on newborn neurobehavior.

METHODS

This was a prospective, naturalistic study. Women were seen at an outpatient research center twice during pregnancy (26-28 and 36-38 weeks gestational age (GA)). Psychiatric diagnoses were assessed using the Structured Clinical Interview for the DSM-IV; medication use was measured with the Timeline Follow-Back instrument. Three groups were established based upon MDD diagnosis and SRI use: Control (N = 56), MDD (N = 20), or MDD + SRI (N = 36). Infants were assessed on a single occasion within 3 weeks of birth with the NICU Network Neurobehavioral Assessment Scale. Generalized Linear Modeling was used to examine neurobehavioral outcomes by exposure group and infant age at assessment.

RESULTS

Full-term infants exposed to MDD + SRIs had a lower GA than CON or MDD-exposed infants and, controlling for GA, had lower quality of movement and more central nervous system stress signs. In contrast, MDD-exposed infants had the highest quality of movement scores while having lower attention scores than CON and MDD + SRI-exposed infants.

CONCLUSION

MDD + SRI-exposed infants seem to have a different neurobehavioral profile than MDD-exposed infants in the first 3 weeks after delivery; both groups may have different neurobehavioral profiles with increasing age from birth.

Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care

Perinatal depression currently receives considerable attention, but not all perinatal women presenting for psychiatric care are depressed. The Edinburgh Postnatal Depression Scale (EPDS) is now routinely administered, but high scores are interpreted as evidence for depressive illness only. This study examined psychiatric diagnoses and mean EPDS scores among perinatal women at a tertiary center. Women accessing care between March 2006 and June 2008 completed a clinical diagnostic interview and the EPDS. Mean EPDS scores were calculated for each psychiatric diagnosis; sensitivity and specificity were calculated for major depressive episode (MDE) and generalized anxiety disorder (GAD). The majority of the sample (N = 91), 49.5%, had GAD comorbid with MDE or another anxiety disorder, followed by MDE (38.5%) comorbid with an anxiety disorder. One third (29.7%) met criteria for MDE and GAD. Only 3.3% had MDE alone and 5.5% had GAD alone. Half the sample (50.5%) had more than one psychiatric disorder. Mean EPDS scores exceeded 11 for the majority of diagnostic groups. Sensitivity of the EPDS for MDE was 0.78 and 0.70 for GAD. Most women had an anxiety disorder and met criteria for more than one psychiatric disorder. Mean EPDS scores were consistently high. Sensitivity of the EPDS for MDE and GAD was comparable.

Are maternal depression or symptom severity associated with breastfeeding intention or outcomes?

OBJECTIVE

Breastfeeding confers many health benefits to mothers and infants, while depression negatively affects mothers and infants. The aims of this study were to determine relationships between (1) major depressive disorder (MDD) and depressive symptom severity during pregnancy and breastfeeding intention; (2) MDD and depressive symptom severity during pregnancy and breastfeeding initiation and status at 2 and 12 weeks; and (3) serotonin reuptake inhibitor (SRI) use and breastfeeding intention, initiation, and status at 2 and 12 weeks.

METHOD

Women were followed prospectively from pregnancy through 12 weeks postpartum for infant feeding intention (breast, breast and formula, formula, and uncertain), feeding practices and MDD (Structured Clinical Interview for DSM-IV Disorders), and depressive symptom severity (Hamilton Depression Rating Scale). Bivariate analyses and multivariable regression modeling were conducted. The study was conducted from July 2004 to September 2007.

RESULTS

Study participants (intention n = 168, initiation n = 151, 2 weeks n = 137, 12 weeks n=103) were well educated (63% college degrees), older (49% ≥ or = 31 years), and predominantly white (77%). At enrollment, 23% had MDD, 21% had significant depressive symptoms, and 16% were taking an SRI. Neither MDD nor depressive symptom severity in pregnancy was related to breastfeeding intention, initiation or duration at 2 and 12 weeks. Intention to exclusively breastfeed was the most significant predictor of breastfeeding initiation and duration. SRI use in pregnancy was negatively associated with breastfeeding intention. SRI use at 2 weeks was negatively associated with 12-week breastfeeding status.

CONCLUSION

Pregnancy is the optimal time to intervene to increase breastfeeding rates. Future research should identify strategies to overcome breastfeeding barriers posed by SRI use.

Psychopharmacologic management of opioid-dependent women during pregnancy

Illicit drug use during pregnancy presents complex clinical challenges, including reducing drug use and treating psychiatric disorders. Pharmacologic treatment of psychiatric disorders in a pregnant woman requires an evaluation of the balance between potential clinical benefit and the risk of potential neonatal consequences. This study describes psychiatric symptoms in 111 opioid-dependent pregnant women and their prescribed psychotropic medications. Hypomania, generalized anxiety disorder and depression were the most common disorders for which psychiatric symptoms were endorsed. Over half of women studied were prescribed some form of psychoactive medication during pregnancy. Pharmacologic vs. non-pharmacologic treatment approaches in this patient population are discussed.

Short-term outcomes of mothers and newborn infants with comorbid psychiatric disorders and drug dependency

OBJECTIVES

The aim of the present study was to determine the characteristics and short-term outcomes of mother-infant pairs with comorbid drug dependency and psychiatric disorders.

METHODS

A population-based retrospective chart review was carried out of 879 drug-dependent mother and infant pairs in New South Wales (NSW) and the Australian Capital Territory (ACT) who delivered between 1 January and 31 December 2004.

RESULTS

Psychiatric comorbidity (dual diagnosis, DD) was identified in 396 (45%) of the 879 drug-dependent women. DSM-IV depression (79%), followed by anxiety (20%), was most prevalent. DD women were more likely to use amphetamines (29% vs 18%, p < 0.05), less likely to use opiates (42% vs 51%, p < 0.05) and to have had no antenatal care (24% vs 8%, p < 0.05). They also had more previous pregnancies (4, range = 2-5 vs 3, range = 2-5, p < 0.05) and domestic violence (29% vs 14%, p < 0.05) was more common. DD infants were less likely to be admitted to a nursery (47% vs 55%, p < 0.05). Withdrawal scores were similar (maximum median Finnegan scores = 4 (interquartile range = 3-8) vs 10 (interquartile range = 7-12, p = 0.30) but fewer needed withdrawal medication (19% vs 27%, p < 0.05). Maternal psychotropic agents did not worsen the severity of neonatal withdrawal.

CONCLUSIONS

Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.

Postpartum depression: how childbirth educators can help break the silence

The voices of women suffering from postpartum depression are often silent. Women are reluctant to reveal to others that they are unhappy after the birth of their babies. Much has been written on possible causes, risk factors, and treatments for postpartum depression, but little has been done to investigate why women take so long to seek help. Early detection and treatment are key to a full recovery. Childbirth educators are in the position to offer anticipatory guidance on possible complications of the postpartum period, including postpartum depression. This article explores why women with postpartum depression choose to suffer in silence and suggests how childbirth educators can help new mothers find their voices.

Psychiatric disorders in pregnant and postpartum women in the United States

CONTEXT

Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking.

OBJECTIVE

To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States.

DESIGN

National survey.

SETTING

Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions.

PARTICIPANTS

A total of 43 093 respondents were interviewed, of whom 14 549 were women 18 to 50 years old with known past-year pregnancy status.

MAIN OUTCOME MEASURES

Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking.

RESULTS

Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders and any substance use, except illicit drug use, than nonpregnant women. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women. The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders. Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status.

CONCLUSIONS

Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period. Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period.

Optimizing Maternal Mental Health Within A Primary Health Care Centre: A Model Program

Depression is a common problem that affects approximately 10 to 15% of pregnant and postpartum women. Health care providers often fail to recognize depression in this population, and pregnant and postpartum women may be reluctant to seek help because of the stigma associated with mental illness. This article describes the Maternal Mental Health Program, an innovative, shared care program that brings together previously fragmented services and co-locates multidisciplinary clinicians within a primary care setting. This approach shows promise with respect to improving mental health outcomes; meeting the needs of women, health care students, and service providers; and increasing awareness of and access to specialized mental health care.

Depression and breastfeeding: which postpartum patients take antidepressant medications?

Depressed breastfeeding women may have concerns about taking antidepressant medications due to fears regarding infant exposure. We examined the clinical records of 73 breastfeeding women who sought depression treatment, to identify characteristics of those who took antidepressants. Compared to women who were not treated with pharmacotherapy, breastfeeding patients who took antidepressants had more severe symptoms, greater functional impairment, more extensive psychiatric histories, and were less likely to be involved in a committed relationship. No differences were found in age, race, or education.

Patient choice of treatment for postpartum depression: a pilot study

OBJECTIVE

The lack of systematic efficacy research makes the selection of optimal treatment for postpartum depression (PPD) difficult. Moreover, the treatment decisions for women with PPD who are breastfeeding are heavily influenced by their concerns about infant exposure to antidepressant medication. The objective of this pilot trial was to examine the clinical characteristics of women with PPD associated with treatment selection.

METHOD

This open pilot trial offered 23 women with PPD one of 3 treatment options: sertraline, interpersonal psychotherapy (IPT), or their combination administered in an outpatient mental health setting over 12 weeks. Baseline and treatment outcome measures included the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Completers across all 3 treatment groups (n = 18) experienced significant clinical improvement with each of the 3 treatment modalities on the HRSD (p < 0.001), BDI (p < 0.001) and EPDS (p < 0.001). There were trends for women with a prior depression to more frequently choose sertraline as a treatment (alone or with IPT, p = 0.07), and for women who were breastfeeding to choose sertraline (alone or with IPT, p = 0.10) less frequently.

CONCLUSION

In this small sample of women with PPD, most women chose IPT with or without sertraline. A larger randomized study could further confirm the suggested predictors of treatment selection identified in this study: previous depression and breastfeeding status.

A psychiatric mother-baby day hospital for pregnant and postpartum women

Major depression and other psychiatric disorders are common during pregnancy and the postpartum period, yet these disorders remain largely under-diagnosed and under-treated. Developing programs that are uniquely tailored to meet the needs of perinatal psychiatric patients can improve both the quality and acceptability of care. In this report, we describe the development and implementation of a novel mother-baby day hospital service designed to meet the mental health needs of this special population, and present preliminary data regarding treatment acceptability and effectiveness. Our experience using this model of care for the past five years has suggested that specialized units such as this one represent an acceptable, effective, fiscally viable approach to the care of pregnant and postpartum psychiatric patients. Further research is needed to more thoroughly assess the effectiveness of this type of specialized perinatal service.