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Clinical Trial
. 2019 Feb 6;19(1):58.
doi: 10.1186/s12884-019-2179-9.

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

Yoshiyuki Tachibana  1 , Noriaki Koizumi  2 , Chikako Akanuma  3 , Hiromi Tarui  3   4 , Eizaburo Ishii  5   6 , Tomomi Hoshina  3 , Ayuko Suzuki  3 , Akiko Asano  3 , Shiho Sekino  3 , Hiroto Ito  7
Affiliations
Clinical Trial

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

Yoshiyuki Tachibana et al. BMC Pregnancy Childbirth. .

Abstract

Background: Perinatal 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.

Methods: We 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.

Results: The 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.

Conclusions: The 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 registration: Name 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.

Keywords: Continuum supports; Mental health; Mother; Multidisciplinary; Postnatal depression; Pregnancy periods; Pregnant.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was reviewed and approved by the Institutional Review Board of the National Center for Child Health and Development, Japan. All participants provided written informed consent.

Consent for publishlication

Not applicable.

Competing interest

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flowchart. Foot notes: PHN - public health nurse; PHC - public health center; * indicates 19 mothers thought to be at risk of psychosocial problems at the time of neonatal home visits by public health nurses (9 mothers did not receive neonatal home visits by the public health nurses); ** indicates 23 out of 138 mothers that did not receive neonatal home visits by the public health nurses; *** indicates 20 out of 115 mothers that were thought to be at risk of psychosocial problems and were followed up by the public health nurses
Fig. 2
Fig. 2
Referral and management protocols for services for women and children with psychosocial problems. Foot notes: In case of women with a past history or familial history of severe psychiatric disorders such as major depressive disorder and bipolar disorder, the occurrence of psychiatric symptoms was assessed and the women were referred to psychiatric services if necessary. “Urgent case” indicates i) strong suicidal ideas or intention of self-harm that cannot be self-managed; ii) sudden emergence of psychotic symptoms; iii) risk of self-harm or causing harm to others
Fig. 3
Fig. 3
Shema of Suzaka Program’s continuum and multidisciplinary maternal and child health service. Footnote: PHN - public health nurse; EPDS - Edinburgh Postnatal Depression Scale
Fig. 4
Fig. 4
The number of pregnant women followed up by the multidisciplinary meetings and were identified as requiring intensive cares. Footnotes: Year 1 indicates the Japanese fiscal year from April 2014 to March 2015; Year 2 indicates the Japanese fiscal year from April 2013 to March 2014
See this image and copyright information in PMC

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