Six-month mental health outcomes among participants in a postpartum care in the NICU (PeliCaN) trial: secondary analysis of a randomized controlled trial

Parents of infants admitted to the neonatal intensive care unit (NICU) face barriers to postpartum care and are at risk for adverse mental health outcomes. The Postpartum Care in the Neonatal Intensive Care Unit (PeliCaN) study evaluated a novel doula-coordinated, midwife-delivered care model for NICU parents. This secondary analysis compared mental health outcomes between participants randomized to the PeliCaN intervention versus usual postpartum care. Postpartum parents of preterm infants < 34 weeks admitted to the NICU with an anticipated stay > 1 week were included. Doulas provided individualized emotional and informational support and coordinated a postpartum midwifery visit within the NICU. Mental health outcomes were compared between groups, including Edinburgh Postnatal Depression Scale (EPDS) scores at enrollment and 6 months postpartum and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores at 6 months postpartum. Of 37 participants enrolled in the parent trial, 34 completed mental health screening and were included. At 6 months postpartum, intervention participants 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) compared with usual care, though not statistically significant. No participants endorsed thoughts of self-harm on EPDS screening at baseline or 6 months postpartum. However, two intervention participants experienced neonatal deaths and disclosed acute suicidality to their doulas outside of screening. Both were connected to emergency psychiatric care. Although screening scores did not differ significantly between groups, doulas identified and facilitated intervention for acute suicidal crises in two high-risk NICU parents, an important exploratory clinical finding that highlights the value of doula-led postpartum support models. ClinicalTrials.gov registration information (for the original PeliCaN Trial) Date of registration: August 22, 2022. Date of initial participant enrollment: November 29, 2022. Clinical trial identification number: NCT05510284. URL: https://clinicaltrials.gov/study/NCT05510284 .