(252) 6-month mental health outcomes among participants in a postpartum care in the NICU (PeliCaN) trial

To compare mental health outcomes among individuals randomized to a co-located postpartum care delivery model in the Neonatal Intensive Care Unit (NICU) (PeliCaN) to controls randomized to usual postpartum care.

Study Design:

This was a secondary analysis of the PeliCaN trial in which postpartum parents of preterm infants < 34 weeks gestation admitted to the NICU with an expected length of stay >1 week were included. Doulas provided comprehensive informational and emotional support tailored to the unique needs of NICU parents and facilitated the coordination of a midwifery postpartum visit within the NICU. Mental health outcomes were assessed including Edinburgh Postnatal Depression Scale (EPDS) scores at enrollment and at 6 months postpartum and post-traumatic stress disorder (PTSD) Checklist for DSM-5 (PCL-5), an assessment of PTSD symptoms, at 6 months postpartum. 

Results:

34/37 of the participants in the parent trial completed mental health screening and were included in this analysis. Participants in the intervention arm had lower mean EPDS scores (4.82 vs. 5.82, p=0.56) and PCL-5 scores (18.7 vs. 22.2, p=0.40) at 6 months postpartum compared to usual care though this did not reach significance. No participants in either group indicated thoughts of self-harm on question 10 of the EPDS at baseline or 6 months postpartum. However, two patients in the intervention arm experienced neonatal deaths and reported acute suicidality to the supporting doulas outside of screening. Both patients were connected to appropriate emergency psychiatric care.  

Conclusion:

While no significant differences in mental health screening scores were detected between intervention and control participants of the PeliCaN trial, doulas were able to successfully identify and intervene on acute suicidal symptoms of two patients. This underscores the value of the doula-led postpartum care model for vulnerable NICU parents, highlighted by the trusting relationships developed and the willingness of parents to seek assistance when facing mental health emergencies.