Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial

Abstract

BackgroundPerinatal mental health problems such as mood disorders are common. We propose a new multidisciplinary health service intervention program providing continuous support to women and their children from the start of pregnancy till after childbirth. The aim of this study was to examine the effects of the program with respect to making women’s mental health better in the postpartum period and improving the state of care for women and their children in the perinatal period.MethodsWe performed a controlled study to investigate the effectiveness of the program in Suzaka City, Japan. The women’s mental health status was assessed using the Edinburgh Postnatal Depression Scale (EPDS) 3 months postpartum. Of 349 women, 210 were allocated to the intervention group and 139 to the control group. From April 2014 to March 2015, the number of the pregnant women who were followed-up by the multidisciplinary meeting in the intervention and control groups were 60 and 4, respectively. In the same period, the number of the pregnant women who were identified as requiring intensive care were 21 and 2, respectively.ResultsThe total EPDS score, which was the primary outcome of the present study, differed significantly between the intervention and control groups (Mean [SD] = 2.74 (2.89) and 4.58 [2.62], respectively; p < 0.001). The number of the women receiving counseling from a public health nurse (5.3% in intervention group, 0.7% in control group, p = 0.02), attending maternal seminars (attendant ratio: 46% whereas 16%, p = 0.01), and receiving home visits by public health nurses (home visit ratio: 93.8% whereas 82.6%, p < 0.001) was significantly higher in the intervention group compared to the control group.ConclusionsThe present study indicates that continuum support provided by integrated mental health care through a multidisciplinary maternal and child health service in the community can make women's mental health better in the postpartum period and help women and their children receive more health services from public health nurses.Trial registrationName of registry: Research for the effectiveness of a multi-professional health service intervention program of continuum supports for mother and child which starts for pregnancy periods to enhance maternal mental health.UMIN Clinical Trials Registry number: UMIN000032424.Registration date: April 29th, 2018.Registration timing: retrospective.Electronic supplementary materialThe online version of this article (10.1186/s12884-019-2179-9) contains supplementary material, which is available to authorized users.

An integrated community mental healthcare program to reduce suicidal ideation and improve maternal mental health during the postnatal period: the findings from the Nagano trial

“…For suicide prevention in general, it is important to assess the risk of suicidal ideation and then provide follow-up and support to women at increased risk of suicide using a high-risk approach [ 74 ]. This was also suggested by our previous study in Suzaka City, Japan [ 44 ]. In that study, public health nurses conducted psychosocial risk assessments for antenatal women and then performed intensive follow-up, if necessary.…”

“…Using a population-based intervention, the self-harm question of the EPDS could identify mothers at increased risk of suicide; therefore, a high-risk approach like that used with intervention program, may be an effective means of decreasing postnatal suicide. Thirdly, this study had a non-randomized controlled study design, which was the same as that used in our previous study [ 44 ]. This design means that other mechanism may explain the effects of the intervention observed in the present study.…”

“…Interventions were designed on the basis of our previous intervention program (the Suzaka trial) [ 44 ], preliminary surveys [ 48 – 50 ] clinical guidelines for perinatal mental health [ 51 ], and discussions among the researchers and with healthcare professionals in the study regions, with a focus on preventing postnatal suicide. The intervention had three characteristics as below based on our previous intervention program [ 44 ]. Firstly, the multidisciplinary maternal and child health service team including public health nurses, obstetricians, psychiatrists, midwives, nurses, medical social workers, and pediatricians shared the referral and management protocol (Additional files 2 and 3 ).…”

“…Since there are many professionals involved, performing collaborative support for mothers and children can sometimes be complex and difficult [ 43 ]. A previous study suggested that multi-professional meetings for supporting mothers and children at risk of psychosocial problems facilitated the collaboration among such a large number of professionals [ 44 ]. Furthermore, the multi-professional support system was shown to improve the mental health among postpartum women.…”

“…The program focuses on reducing suicidal ideation in postnatal women at risk of psychosocial problems and improving their mental health. We developed a clear referral and management pathway for antenatal and postnatal women with psychosocial problems [ 44 – 47 ]. The present study’s intervention functions in combination with our earlier mother and child healthcare support program that spans the various pregnancy periods.…”