Clinical Outcomes from a Collaborative Care Program to Treat Perinatal Depression and Anxiety

Objective: To evaluate a collaborative care program in an obstetrics and gynecology (OB/GYN) practice for the treatment of perinatal depression and anxiety symptoms. Methods: We conducted a retrospective chart review from the electronic medical records of N = 185 patients enrolled in a perinatal collaborative care program delivered by a behavioral health company, Family Well Health, in partnership with a large OB/GYN practice in Massachusetts (USA). FamilyWell’s collaborative program includes telehealth sessions with a certified coach or a licensed therapist, medication management, and implementation assistance to enhance depression screening, assessment, and treatment of perinatal mood and anxiety disorders (PMADs). English-speaking adults (aged ≥18 years) who screened positive for depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥ 10) by their OB/GYN clinician were referred to the FamilyWell program. Enrolled patients received weekly or biweekly telehealth sessions with a certified coach (77%) or licensed therapist (23%) and completed monthly electronic symptom assessments for anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]) and depression (Patient Health Questionnaire 9-item scale [PHQ-9]). Assessment scores were monitored by a behavioral care manager. We evaluated three clinical outcomes including change in GAD-7 and PHQ-9 scores, treatment response (50% or greater decrease in GAD-7 or PHQ-9 scores), and symptom remission (follow-up PHQ-9 or GAD-7 score <5). Results: Over 80% of referred patients enrolled in CoCM and more than 70% completed their intake session within one week. At baseline, 86% had a positive GAD-7 or PHQ-9 score (GAD-7 or PHQ-9 ≥ 10 indicating symptoms of moderate, moderate-severe, or severe depression or anxiety). PHQ-9 scores decreased by 1.3 points per month (95% CI [-1.5, -1.2], p < .001) and GAD-7 scores decreased by 1.3 points per month (95% CI [-1.5, -1.2], p < .001). Forty-seven percent of patients (n = 33) demonstrated depression treatment response and 52% (n = 45) demonstrated anxiety treatment response. In addition, 30% of patients (n = 26) experienced anxiety symptom remission at least once in a mean time of 3.2 months and 31% (n = 22) experienced depression symptom remission in a mean time of 3.5 months. Patients received a mean of 8 sessions with a therapist and 9 sessions with a coach before experiencing symptom remission. Conclusion: These data suggest that implementing a tech-enabled, coach-driven collaborative care program is associated with decreases in depression and anxiety symptoms. Symptom remission occurred within 8 sessions with a therapist or 9 sessions with a coach. Unlike other psychiatric collaborative care programs described in the literature, this program uniquely addresses the behavioral health workforce shortages by integrating certified coaches as a primary intervention and utilizes text-based support to enable scale. Our results suggest that this integrated behavioral health approach can be implemented outside the research setting.