With an increasing national focus on early identification of depression in pregnancy or postpartum, the Day Hospital at Women & Infants Hospital in Providence, R.I., continues to help treat expectant or new moms in a unique setting.
The Day Hospital opened in 2000 as the nation’s first perinatal partial hospital program treating pregnant women and new mothers (joined by their babies) with depression, anxiety or other emotional distress. The concept of having the newborn accompany the mother to treatment was a new one when the program began, and is a cornerstone of treatment at the Day Hospital.
“We like to see mom and baby together for our individual appointments as much as possible. The style and quality of the interaction between mom and baby is part of the assessment and treatment,” said Shannon Erisman, Ph.D., clinical director of the Day Hospital.
Women may attend the program while pregnant or postpartum with their infant. Postpartum moms typically start attending about two weeks after delivery. Treatment – which runs from 8:30 a.m. to 2:30 p.m. daily, with an average two-week stay – is tailored to the individual patient and includes group programming, which focuses on areas such as coping skills, psychoeducation, and attachment between mother and child, including an infant massage group.
“In addition to group therapy, our moms have daily individual therapy and see a prescriber as needed,” Erisman said. Most of the participating mothers opt to be treated with medication for their depression, anxiety or other behavioral health issues, she said.
Erisman said the orientation of the therapy offered is IPT (interpersonal therapy) and DBT (dialectical behavior therapy).
The hospital has an outpatient department as well, so some patients continue to be seen once their stay in the Day Hospital is completed, while others are referred to outside clinicians and treatment centers. “We also offer an aftercare group,” which helps participants continue to meet and maintain connections once the program is complete. “We make sure they are engaged with their outpatient providers, continuing to practice skills learned in the program, and also are maintaining that support with other moms,” she said.
The program originally started with a capacity for six women, but was expanded about a year-and-a-half ago to accommodate more than a dozen patients. The program is often at capacity and because of an increase in awareness and screening, there is sometimes a brief waiting period to get into the program. “Sometimes we don’t have a wait at all, but it’s been more and more common that we will not be able to admit women immediately after their initial evaluations,” Erisman said. “There’s more and more demand.”
Postpartum depression affects 10-20 percent of mothers, Erisman said. She said there has been a national movement toward more screening, and many of the women who participate in the program were referred after screening in their OB/GYN or pediatrician’s office.
“There’s one measure in particular that has strong research support and is frequently utilized, the EPDS (Edinburgh Postnatal Depression Scale),” she said. “It is used as a screening tool in OB/GYN offices because often that is one of the only points of contact women have with a provider, with their OB/GYN or with the pediatrician for their baby. These providers are able to capture these moms who are already experiencing symptoms or may be headed in that direction.”
Catching symptoms pre-birth is important. “We know moms who develop depression during pregnancy are much more likely to be at risk for postpartum depression, so being able to identify and treat them early dramatically improves their trajectory,” Erisman said.
Stress during pregnancy can affect the developing fetus. “We know moms with anxiety or depression during pregnancy have babies who develop problems later on, including cognitive and behavioral issues,” Erisman said. Those problems are exacerbated when the baby enters the world, if the mother is still facing these issues.
“There are things depressed moms don’t do that non-depressed moms do,” she said. For example, “They demonstrate reduced eye contact with the baby; they don’t spontaneously talk to the baby. The interactions are really, really different and it affects babies’ development and attachment.”
Erisman said satisfaction data (from 2007-2012) for the Day Hospital showed that 97 percent agreed or strongly agreed that the program had been helpful to them, 99 percent would recommend the program to others, and 95 percent reported they were currently using the skills they learned at the Day Hospital. EPDS severity scores at intake also have showed a statistically and clinically significant reduction in symptoms at discharge.
“For a lot of the moms, this is their first contact with mental health services, so they are very anxious when they come in,” she said. “They don’t want to share their personal information with other people, not even their therapists. By the end – it is very hard for them to leave. They develop a strong positive attachment with us. Almost universally, our moms express relief at knowing they are not alone.”
By Pamela Berard