Evaluating the clinical efficacy of a primary care‐focused, nurse‐led, consultation liaison model for perinatal mental health

Abstract

In Australia, perinatal mental illness is common, although poorly identified and treated. Improved perinatal mental health depends on service provision models that reflect a focus on promotion, prevention, and early intervention, while facilitating improved referral pathways between primary health and specialist mental health services. In 2008, a contemporary community-based model of mental health service provision was developed as an alternative to the pre-existing hospital-based service model. The model is delivered primarily by mental health nurses using a consultation liaison framework. It provides for specialist mental health assessment and brief intervention in collaboration with the general practitioner, who remains the primary health provider. It also aims to raise community awareness and build capacity for the management of perinatal disorders in the primary care sector. Evaluation of the clinical effectiveness of the model, and the improvement in access for primary health providers and women, was conducted at 2 years from its implementation. Clinical effectiveness was evaluated by using comparative data from the Edinburgh Depression Scale and Depression Anxiety and Stress Scale, and the results demonstrated clinical efficacy. Improved attendance rates indicated that women preferred this community-based service model as an alternative to the pre-existing service model.

Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings

“…21-24,27,31-33 Several studies did not report participants' ages or other details of participants' characteristics (n=5). 3,19,20,26,29 Four studies separated age into categories and did not report the participant's average age. 2,25,28,30 …”

“…Only three studies used a structured diagnostic interview to assess for a diagnosis of Major Depressive Disorder. 3,29,31 One study did not specify a cut off score for depression. 29 …”

“…While the majority of studies screened both during pregnancy and the postpartum period (n=10), 2,3,19,20,22-26,31 some only screened during pregnancy (n=3) 27,28,30 or in the postpartum period (n=3). 21,32,33 A minority of the studies assessed change in depression score over time (n=5) 21,23,29,31,33 and those that did used differing approaches with varying results (Appendix 2, available online at http://links.lww.com/xxx). 21,26 None of the studies assessed the extent to which depression scores improved to indicate remission of depression.…”

“…2,3,19-24,26-29,31-33 Results for treatment participation and depression outcomes differed according to the type and intensity of the intervention (Table IV and Figure II). As demonstrated in Figure II, studies may be placed in three groups: 1) those with no intervention; 2) those with low-intensity interventions that targeted one or two levels of barriers (patient, provider, or practice) to mental health care use; or, 3) those with high-intensity interventions that targeted all three levels of barriers (patient, provider, and practice).…”

“…For example, studies including interventions targeting patients with systematic follow-up, supportive therapy, or support groups were associated with an average mental health care use rate of 31%. 21,24-26,29 Those including interventions targeting patient and provider barriers with patient engagement strategies (44%), on-site assessments (49%) and perinatal care provider training (54%) were associated with double the rate of mental health care use. Studies that targeted all three levels of barriers (patient, provider, and practice) to treatment were the most effective as measured by participation in an initial mental health assessment.…”