Multidisciplinary Program Improves Perinatal Depressive Symptoms

Nicole Tarui, MD

CONFERENCE REPORTER

A multidisciplinary program designed to support perinatal women was effective in reducing depressive symptoms as measured by the Edinburg Postnatal Depression Scale (EPDS), according to a research poster at the 2023 American Psychiatric Association Annual Meeting.¹

The study included 88 patients between 22 weeks gestation and 2 years postpartum who were enrolled in the Maternal Outreach Mood Services (MOMS) program between July 2020 and June 2022. The most common diagnoses included major depressive disorder (MDD; n=57), bipolar I disorder (BDI) manic with psychosis (n=5), and generalized anxiety disorder (GAD; n=4). Participants received daily group therapy for up to 6 hours/day, weekly individual therapy, and biweekly or weekly medication management visits with a perinatal psychiatrist. Treatment engagement averaged between 8 and 10 weeks in duration.

Investigators found a 60% mean reduction in EPDS scores at discharge as compared with admission when looking across all diagnoses. The greatest reduction was for those who met criteria for BDI manic with psychosis; the mean decrease in EPDS was 71%. Those with MDD and GAD had mean decreases of 61% and 62%, respectively.

The MOMS program is a multidisciplinary partial hospital program and intensive outpatient program and a collaborative effort between El Camino Health maternal health services and the Scrivner Center for Mental Health & Addiction Services. MOMS provides education, counseling, and evaluation for expectant and new mothers.

Psychiatric Times^® spoke with poster presenter Nicole Tariu, MD, psychiatrist at El Camino Health and medical director of the MOMS program, about this research and the importance of supporting women during the perinatal period.

Psychiatric Times: Can you tell readers more about the MOMS program and how it works?

Nicole Tarui, MD, MPH: The MOMS program is a mother-baby-based partial hospitalization program and intensive outpatient program. It is designed to provide treatment for individuals experiencing psychiatric conditions in the perinatal period. Treatment includes group therapy, individual therapy, and medication management.

For patients beginning treatment, there can often be significant isolation and fear around engaging in treatment for the first time. Thus, group therapy is very important for individuals to connect with one another and to have a community of support. It is a powerful way for patients to learn from each other and know they are not alone in the recovery process.

In individual therapy, each patient works on developing a toolkit of skills to be able to manage their symptoms—not only while they are in the program but well into the future. We draw upon numerous therapeutic modalities including cognitive behavioral therapy, dialectical behavioral therapy, and infant parent psychotherapy.

With regard to medication management, I discuss with patients potential risks and benefits of medication in both pregnancy and breastfeeding. I help patients make an informed decision if medication is the right choice for them.

I also work very closely with mothers and their babies to support the development of secure attachment through infant-parent psychotherapy. Having both mother and baby in the program together is a very unique opportunity for us to work through challenges and help strengthen the bond between them.

The program was designed to treat the whole individual. When a patient comes to treatment for the first time, there is often a lot of fear and stigma around what it means to have a psychiatric condition. We strive to understand each individual for who they are—their strengths, experiences, and histories. In doing so, we help patients understand they are not defined by their symptoms or their diagnosis. We hope to provide a supportive environment for healing in which individuals can focus on recovery in an individualized way.

We strive to understand each individual for who they are—their strengths, experiences, and histories. In doing so, we help patients understand they are not defined by their symptoms or their diagnosis. We hope to provide a supportive environment for healing in which individuals can focus on recovery in an individualized way.

The care is provided by a multidisciplinary team, which includes providers from a wide range of training backgrounds like social workers, psychologists, nurses, occupational therapists, and perinatal psychiatrists. We all work together to help support our patients in the healing journey. We work very closely together daily, and we meet as a team weekly to discuss how patients are doing and communicate how they are progressing in the program. It is invaluable to have the perspectives of multiple providers from different backgrounds, and I think this contributes to our understanding of the whole individual.

Psychiatric Times: Did any of the study participants have pre-existing psychiatric disorders?

Nicole Tarui, MD, MPH: Many of the patients we treated had a history of psychiatric conditions prior to pregnancy. However, some patients experienced symptoms for the first time either in pregnancy or in the postpartum period. For the individuals who had psychiatric conditions prior to pregnancy, the range of symptoms and overall stability was quite variable. What we did note for these patients was that, in general, symptoms increased either during pregnancy or postpartum, which led them to engage in the MOMS program.

Psychiatric Times: Did any of the women have their medications changed before or during pregnancy due to safety concerns?

Nicole Tarui, MD, MPH: Medication changes were common for a lot of the women leading up to pregnancy or during pregnancy. There is a lot of information about exposure risk during pregnancy, but a very important part of the conversation that is often lacking is the risk of untreated symptoms. There are many key factors when making decisions about medication changes, especially prior to conceiving and during pregnancy: prior psychiatric history, the severity of symptoms, potential exposure risk, and the risk of untreated symptoms for both mom and baby.

Psychiatric Times: How satisfied were the patients with the program? Do their partners participate in the program as well?

Nicole Tarui, MD, MPH: Patients were very satisfied with the care provided in the MOMS program, as evidenced by the feedback we have received in addition to the overall level of improvement that was reflected in the data results.

I recently had a patient who shared with me on her day of graduation that at the point that she entered treatment she had lost all hope. She had just accepted that this was her life: it was destined to be hard and no change was possible. Gradually, she was able to overcome the stigma of her illness and her symptoms, and she was able to share with us how much she was suffering. When she was able to open up, she could then accept the help and, in that process, she learned that she could also ask for help from people around her. She shared with me that she had renewed hope that no matter what challenges she may face in parenthood there is a community and support to help her.

We have a weekly partner’s group that is inclusive of any support person the patient wants to include. We often include family members in treatment in individual sessions as well. Education is a very key aspect to support a loved one going through the recovery process. We help family members understand what their loved one is experiencing and how they can provide support.

Psychiatric Times: What are you most excited about regarding these findings?

Nicole Tarui, MD, MPH: The most exciting aspect of these findings is being able to see the impact of the treatment happening in the MOMS program. From the time of admission to discharge, patients across all diagnoses had an average 60% decrease in EPDS scores. Clinically, that is a significant difference. And for many patients, that equates to being able to return to their baseline, care for themselves, and their families.

Patients across all diagnoses had an average 60% decrease in EPDS scores. Clinically, that is a significant difference. And for many patients, that equates to being able to return to their baseline, care for themselves, and their families.

Psychiatric Times: What are next steps, both in terms of future research as well as future program development and implementation?

Nicole Tarui, MD, MPH: In the future, I hope to be able to understand the impact of specific interventions and their outcomes. We use a variety of treatment modalities in combination with medication management, group, and individual therapy. It would be invaluable to understand which interventions have the most impact.

Recently, we have focused on infant-parent psychotherapy and provide trainings for the therapists in the MOMS program. My goal is to continue to develop attachment work in the MOMS program and conduct ongoing research to understand outcomes on attachment between the mother and baby.

In my opinion, there are very few preventative interventions in the field of psychiatry. Infant-parent psychotherapy can help parents break the cycle of intergenerational trauma. In helping the parent understand their own history and patterns of relationships, this can simultaneously set the stage for healthy attachment to the infant. I believe this has the potential to have long lasting benefits for both the infant and parent.

We have a very unique opportunity to do this work in the MOMS program as we have both the mother and infant together in treatment.

Are you attending the conference? Share your thoughts with us via PTEditor@mmhgroup.com, social media, or visit us at Booth 1040.

Reference

1. Tarui N, Dhami NK, Baker B. Treatment of Perinatal Conditions in the Maternal Outreach Mood Services (MOMS) Program: An Analysis of Epds Scores in PHP/Iop Levels of Care. Presented at 2023 American Psychiatric Association Annual Meeting. San Francisco, California. May 23, 2023.