Developing a Perinatal Depression Clinic within a Psychiatry Residency Program
Introduction: About 12.7% of women screen positive for depression during pregnancy; this increases to 21.9% during the 12-month postpartum period. When identified, perinatal depression is amenable to a variety of treatment modalities including pharmacotherapy for severe cases. Despite the availability of effective treatment and the frequency of contact with medical providers, as many as 50 to 57% of women suffering from perinatal depression fail to get treatment they need due to barriers both within and outside the healthcare system. To improve the delivery of care to perinatal women in our community, a Women’s Behavioral Health Clinic (WBHC), was established within Wmed psychiatry residency program. The WBHC was developed to (1) assess the feasibility of establishing a psychiatric clinic focused on treating perinatal women (2) determine if the WBHC treatment improves depression in perinatal women, and (3) to identify psychosocial factors that impact the success of treatment. Purpose: To determine the effectiveness of combined psychopharmacological and supportive psychotherapeutic treatments in women with perinatal mood disorders, and the proportion benefitting from psychiatric care. Methods: The Mother’s Mind Matters project, a community wide education effort about perinatal depression promoted early and frequent prenatal mood disorder screening by obstetrics providers and prompt treatment or referral for psychiatric services. While most women identified were referred for psychotherapy, more complex cases required psychiatric care. Over 33 months, 271 perinatal women were referred to the Women’s Behavioral Health Clinic (WBHC) established within the psychiatric residency program of Western Michigan University Homer Stryker School of Medicine. One-hundred women had ≥2 visits, and 64 women had multiple Edinburgh Postnatal Depression Scale (EPDS) scores recorded. Results: Number of visits was 6±4 (median=5, mode=3). Baseline EPDS mean score =20.5, and last measured EPDS mean score =7.7 (p<0.0001). EPDS <11 (remission) was achieved in 61%, EPDS <13 in 73%. Average rate of score change =6.6 points/visit, averaging 3 visits to remission, and =1.6 points/week, averaging 2 months to remission. Race was the only variable significantly associated with EPDS reduction. About 1/3 showed no significant improvement in EPDS scores, either continuing to struggle under psychiatric care or dropping out altogether. Three women required hospitalization, primarily for psychoses. Conclusions: Brief psychiatric intervention with appropriate use of psychotropic medications represents effective management for most of the severe cases of perinatal mood disorder in our community. Case management to keep women engaged in treatment may increase effectiveness, especially among those experiencing poverty and other social problems.