Hospitalization-Based Treatment for Postpartum Depressed Mothers and Their Babies: Rationale, Principles, and Preliminary Follow-Up Data

Abstract

This paper describes the rationale and treatment principles of a mother-infant unit for severely depressed mothers and their infants in Flanders (Belgium). The unit integrates systemic, psychodynamic, and cognitive behavioral treatment approaches, and aims at improvements on three levels: (1) improving mood and interpersonal relationships in depressed mothers, (2) fostering a positive mother infant relationship, and (3) establishing a supportive environment outside the treatment setting for both mother and infant. In addition, we present preliminary data of a 3.5-year naturalistic follow-up study of postpartum depressed mothers (n = 41) admitted at this mother-infant unit between April 2003 and April 2005. Results showed that at 3.5-year follow-up a considerable subgroup of mothers (61%) were functioning relatively well, as indicated by low levels of depressive symptoms, anxiety and anger, negative affect, and relatively high levels of positive affect. Yet, in line with other studies, a relatively large subgroup of mothers (39%) continued to suffer from (severe) depression during follow-up. Using a Life History Calendar method, it was found that, compared to currently nondepressed mothers, mothers who were depressed at follow-up did not have more depressive episodes but had longer depressive episodes, received more psychotherapy after hospitalization, and experienced more negative life events during the 3.5-year follow-up period. Implications of these findings for future research and intervention strategies in postpartum depression are discussed.

A systematic review of research on psychiatric mother-baby units

“…However the French version has more details on paternal disorders, drug treatments and past-history of both parents (Cazas et al 2004). In terms of drawing on the same empirical study, Vliegen and colleagues use the same sample and similar instruments (Vliegen et al, 2010;Vliegen et al 2013). …”

“…When specific MBUs were named in the 44 publications, it was evident that there are multiple sources collecting data from the same places: Bethlem Royal Hospital in South London, UK (Kenny et al 2013;Pawlby et al 2010;Seneviratne et al 2003), Wythenshawe Hospital in Manchester, UK (Antonysamy, Wieck, and Wittkowski 2009;Neil, Sanderson, and Wieck 2006), Austin Hospital in Melbourne, Australia (Bilszta, Buist, Wang, and Zulkefli 2012;, Helen Mayo House in Adelaide, Australia (Connerty et al 2015;Yelland et al 2015); and unnamed MBUs in Belgium (Vliegen et al 2010;Vliegen et al 2013) and Manchester in the UK (Wan, Salmon et al 2007;Wan, Warburton et al 2007; highlights that aside from the larger scale Marcé database information, studies focus on a small number of MBUs.…”

“…A three and a half year follow-up study in Belgium found that 61% of mothers were functioning 'relatively well', but 39% continued to be impacted by severe depression (Vliegen et al 2013;Vliegen et al 2010). In the UK, Hipwell et al's (2000) follow-up study of 82 mother-infant dyads over the child's first year of life found that mother-infant interactions were still impacted negatively by the mother's illness.…”

The Course of Postpartum Depression

“…23,29,42,43 In the study by Holden and colleagues, 23 depression levels decreased below the cutoff for the treated mothers but not for the control sample (see Table 3). In the study by Milgrom and Beatrice, 39 a cutoff score for the Hamilton Depression Rating Scale (HDRS) was not reported.…”

“…25,26,42,43 Howell and colleagues 35 found that chronically depressed mothers showed a smaller reduction in postpartum physical symptoms over time compared to the remitted group. This study also showed that the incidence of health problems in the infants, such as colic and illness, did not differ between remitted and chronic PPD mothers.…”