Program Is Proactive About Perinatal Mood Disorders

Denver, CO—The number 1 complication of pregnancy is not diabetes or hypertension—it is the development of a mood disorder. And the risk does not end with pregnancy; it extends from conception through the first year postpartum.

At the Association of Women’s Health, Obstetric and Neonatal Nurses 2011 annual convention, Pat Bradley, BS, RNC, a nurse at Edward Hospital, Naperville, IL, described her institution’s commitment to recognizing and treating this common condition.

“This is really a community effort. When we got active in this area, counselors in the community volunteered their time for support groups,” she said. “People are passionate about this topic and are devoted to getting help to these patients.”

What makes the program special is the buy-in from the whole medical community. The intervention does not begin and end in the obstetrician’s office, but extends to pediatricians, family physicians, and of course, a host of mental health specialists—all united in the mission of improving the lives of these patients, said Ms Bradley, who presented the findings of a study on the pilot screening program.

Among pregnant women, 5 of 100 develop diabetes, and 6 of 100 have hypertension. But 20 of 100 women suffer from a perinatal mood disorder, she said.

“Many are diagnosed with a mood disorder prior to pregnancy, but pregnancy complicates it,” she said. “On top of that, 20% of all pregnant patients develop a mood disorder during pregnancy. Our physicians tell us that many have anxiety that interferes with daily life,” she said.

Perinatal mood disorders include generalized anxiety and depression (15%-20%), panic disorder (10%), posttraumatic stress disorder (6%), obsessive-compulsive disorder (3%- 5%), bipolar disorder (0.5%-1.5%), and psychosis (0.1%-0.2%).

Edward Hospital recognized the need to be proactive in this area, and partnered with the behavioral health service at Linden Oaks at Edward 4 years ago to develop a multifaceted screening and treatment program. In the pilot program, all obstetric patients were screened immediately postpartum for postpartum depression with the Boyer screening tool. Depending on the patient’s re sponse, the woman would receive a follow-up phone call, assessment with a psychiatric nurse liaison and/or social worker, counseling with a trained psychologist, or referral to a psychiatrist.

The percentage of patients scoring “at risk”—around 20%—mirrored the latest research in postpartum depression. Of the women screened, 2% to 3% required a psychiatric service of some sort, Ms Bradley said.

The pilot evolved into a comprehensive program involving a multidisciplinary team, with screening occurring at multiple points in time. Four obstetric practices and the Edward Hospital highrisk perinatal clinic now screen their patients using a modified Boyer risk assessment tool in the first trimester and the Edinburgh Postnatal Depression Scale in the second trimester.

“The physician needs to make only 1 phone call regarding an at-risk patient,” she said. “A behavioral health specialist takes it from there, assessing the patient, hooking her into the appropriate service, and reporting back to the physician.”

Nurses or behavioral health specialists check on mothers via telephone and if mood changes are detected, patients are rescreened and referred for help, as indicated. Outpatient services now include support groups led by mental health specialists, as well as a dedicated phone line.

After delivery, pediatricians and family physicians become part of the network. “We recognized the need to shift over to the doctor who sees her regularly,” she noted. “We want these doctors to do formal screening, and some do (using the Edinburgh Postnatal Depression Scale), but in the very least, they know they should ask the mother, ‘how’s it going?’ and key in to her response.”

Although the investigators do not have formal data on the program’s effectiveness, they do know that referrals to behavioral health specialists in the network and in the community have increased, and, anecdotally, women seen through this service report feeling less depressed and more capable of caring for their infants. n