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J Am Psychiatr Nurses Assoc. 2020 Jan 3:1078390319897311. doi: 10.1177/1078390319897311. [Epub ahead of print]

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

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Diane Goedde, MSN, APRN, Billings Clinic, Billings, MT, USA.
Astri Zidack, EdD, LCPC, CRC, Billings Clinic, Billings, MT, USA.
Ya-Huei Li, PhD, Billings Clinic, Billings, MT, USA.
Diane Arkava, MSW, LCSW, Billings Clinic, Billings, MT, USA.
Elizabeth Mullette, MSN, RN, Billings Clinic, Billings, MT, USA.
Yvonne Mullowney, BS, Billings Clinic, Billings, MT, USA.
Jeannine M. Brant, PhD, APRN AOCN, FAAN, Billings Clinic, Billings, MT, USA.


BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.


depression; postpartum depression; pregnancy and postpartum; psychiatric nursing practice


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