Improving perinatal mood and anxiety disorders through integrated infant mental health care in obstetrics: evidence from a program evaluation study.

BACKGROUND

Depression and anxiety in the perinatal period affect many women and have multiple negative impacts on the mother and baby. The Integrated Infant Mental Health approach embeds a Behavioral Health Consultant (IMH-BHC) who has specialized training in Infant Mental Health into OB/GYN clinics. This manuscript reports a quasi-experimental comparison of two groups of women through pregnancy and the first year postpartum, receiving integrated IMH care versus standard OB care. We hypothesized integrated IMH care patients would show less anxiety and depression across pregnancy and postpartum than comparison patients.

METHODS

Using a quasi-experimental design, we compared integrated IMH care patients with standard OB care patients to evaluate the primary outcomes of depression and anxiety symptoms from pregnancy through 12 months postpartum across ten obstetric clinics (seven treatment clinics and three comparison clinics) between 2018 and 2021. Data collection included questionnaires in-person, then over the phone during the COVID-19 pandemic. Regression analysis, using fixed effects models to accommodate differences between clinics, compared changes in number of symptoms over time between treatment and comparison groups. Logistic regression was used for comparing number of participants above clinical cutoffs for anxiety and depression symptoms in late pregnancy and at 12-months postpartum. Piecewise linear modeling was used to examine trajectories of symptoms of anxiety and depression.

RESULTS

During pregnancy, depression scores for the intervention group (n = 90) remained constant whereas depression in the comparison group (n = 68) increased across the later stage of pregnancy. The slope of change for depression scores across the postpartum year was not significantly different in the two groups. Anxiety symptom trajectories did not differ significantly by group membership during pregnancy or in the postpartum period. The intervention group was less likely to be married, to own their homes, or to have completed schooling beyond high school. More participants in the intervention group identified as Black or non-White. Propensity score weighting achieved equivalence in demographics between intervention and comparison groups.

CONCLUSIONS

Our findings suggest possible benefits of the integrated IMH model for maternal wellness, most notably for depression symptoms during late pregnancy in a sample of women with high comorbid risk. Supporting at-risk dyads through programs like integrated IMH care represents a much-needed intervention that may make a meaningful difference in the lives of families.