Multidisciplinary closed-loop care for perinatal anxiety and depression: Reflections on a structured intervention model

Abstract

The study presents a systematic and clinically grounded multidisciplinary closed-loop intervention model for pregnant women experiencing anxiety and depression. The program incorporates coordinated obstetric, psychological, nutritional, and rehabilitative care to improve pregnancy outcomes and postpartum recovery. The intervention significantly reduced caesarean section rates, adverse maternal events, and neonatal complications, while enhancing vaginal delivery progression and pelvic floor muscle recovery. The model places emphasis on structured psychological support, team-based education, and continuous follow up, allowing timely adjustment of care. The authors propose a comprehensive management pathway that strengthens intervention continuity and clinical responsiveness. This approach offers a practical framework for improving perinatal mental health and maternal wellbeing, supporting its wider adoption in clinical settings.

Key Words: Perinatal anxiety; Perinatal depression; Closed-loop care; Multidisciplinary intervention; Pregnancy outcomes; Maternal mental health; Perinatal care; Obstetric care

Core Tip: This study shows that multidisciplinary closed-loop care can improve labour outcomes, reduce obstetric and neonatal complications, and support postpartum functional recovery in women with perinatal anxiety and depression. Its structured, continuous model offers an effective pathway for integrating psychological care into routine maternal health services, multidisciplinary closed-loop care improves labour, postpartum and neonatal outcomes.

INTRODUCTION

The article[1] with considerable interest, as it addresses an area of increasing clinical concern: The impact of perinatal anxiety and depression on both maternal and neonatal wellbeing. The authors present an organised multidisciplinary closed-loop model that connects psychological assessment, timely intervention, cooperative care across departments, and consistent follow-up. This framework is particularly noteworthy because it mirrors real-world clinical processes and can be implemented even in settings with limited mental-health resources.

Multidisciplinary closed-loop care model is based on a multidisciplinary consultation framework that brings together specialists from obstetrics, psychology, neonatology, pelvic floor rehabilitation, internal medicine, traditional Chinese medicine, and nutrition. Through coordinated collaboration, these disciplines contribute to the development of comprehensive mental health care strategies spanning the pre-pregnancy, antenatal, and postpartum periods. The intervention emphasizes structured group engagement, encouraging experience sharing, emotional support, and positive behavioural learning to promote personal resilience, reduce psychological distress, and strengthen adaptive coping skills. An integrated closed-loop management process consisting of assessment, targeted intervention, continuous follow-up, and iterative optimization ensures individualized yet consistent care delivery. By combining interdisciplinary coordination with ongoing feedback, this approach improves intervention efficiency and provides a more robust and sustainable framework for addressing maternal mental health challenges. The study findings demonstrate clear clinical value. The significantly lower caesarean section rate in the intervention group (31.7%) compared with controls (44.2%) suggests that stabilising emotional status may improve labour progression. The reductions in maternal complications, postpartum haemorrhage, abnormal delivery duration, and neonatal adverse outcomes highlight the physiological and behavioural influence of anxiety and depression during pregnancy. These improvements align with current evidence that maternal psychological distress can disrupt neuroendocrine regulation, pain perception, and uterine contractility. Another important contribution of this study is its evaluation of postpartum pelvic floor recovery. The intervention group showed better muscle strength and repair at six weeks postpartum, indicating that psychological wellbeing supports physical rehabilitation. Few studies have explored this connection, and the present results offer direction for integrating mental-health care into postpartum recovery programs. The closed-loop model also demonstrates good operational practicality. It relies on cross-department collaboration, structured communication, and stepwise follow-up rather than specialised psychiatric staffing alone. This approach may help bridge the common gap between obstetric care and mental-health services, providing a more continuous and predictable treatment experience for pregnant women (Table 1).

Table 1 Effectiveness of the multidisciplinary closed-loop care model compared with routine care in improving delivery outcomes, reducing maternal and neonatal complications, and enhancing postpartum pelvic floor function[1].

Parameter	Control	Intervention	P value
Vaginal delivery (%)	55.8	68.3	0.046
Caesarean section (%)	44.2	31.7	0.046
Normal labour (%)	86.5	96.3	0.029
Intact perineum (%)	32.8	50.0	0.035
Maternal adverse outcomes (%)	32.5	15	0.0014
Neonatal adverse outcomes (%)	15.8	6.7	0.025
Pelvic Floor Function Pre-resting scores (mean values)	59	63	< 0.001
Pelvic Floor Function Fast-twitch scores (mean values)	70	73	0.021
Pelvic Floor Function Slow-twitch scores (mean values)	67	72	< 0.001
Pelvic Floor Function post-resting scores (mean values)	63	66	0.002

While the study offers promising results, future research may consider extending follow-up to evaluate long-term maternal mental health, bonding outcomes, and pelvic floor function. Stratifying outcomes by severity of anxiety and depression could also refine clinical application. Nonetheless, this trial represents an important step toward standardising mental-health integration in obstetric care. I commend the authors for their thoughtful design, robust clinical implementation, and contribution to advancing multidisciplinary maternal care. Their work provides a strong foundation for further development of structured mental-health pathways in perinatal medicine.

CURRENT SITUATION AND CHALLENGES OF CARE FOR PERINATAL ANXIETY AND DEPRESSION

Perinatal anxiety and depression remain major concerns in maternal healthcare, affecting women throughout pregnancy and extending into the postpartum period[2-7]. These psychological conditions exert a measurable influence on maternal physiology, labour progression, and neonatal wellbeing[8-10]. Despite increasing awareness, the current clinical approach to managing perinatal mental-health disorders is often fragmented, with inconsistent screening, delayed intervention, and inadequate coordination between obstetric and psychological services[11-13].

The prevalence of prenatal and postnatal depression and anxiety disorders was highest in low- and lower-middle-income countries[14-17]. One of the principal challenges lies in the limited integration of mental-health assessment into routine prenatal care. Many women receive only symptom-based evaluations rather than structured psychological screening, which increases the likelihood of missed or late diagnoses[18,19]. The untreated anxiety and depression can lead to prolonged labour, higher rates of caesarean delivery, increased maternal complications, and suboptimal neonatal outcomes[20,21]. These findings affirm the clinical urgency of early detection and structured intervention[22-27].

Another difficulty relates to insufficient continuity of care. Conventional care pathways often lack mechanisms for ongoing monitoring, feedback, and multidisciplinary communication. This can result in gaps between evaluation and follow-up, limiting the effectiveness of psychological support during critical periods[28,29]. The study highlights that fragmented care may fail to stabilise emotional fluctuations that influence both maternal behaviour and physiological adaptation during childbirth. There is also a shortage of specialised mental-health personnel in many clinical settings, particularly in community hospitals[30]. This shortage can hinder timely psychological intervention, leaving healthcare teams unable to respond adequately to emotional distress that evolves rapidly during pregnancy and the early postpartum stage[31-33].

Finally, the postpartum period presents additional challenges. Pelvic floor weakness, changes in physical functioning, and adjustment to newborn care may intensify psychological vulnerability. The authors’ findings that improved mental-health support enhanced pelvic floor recovery at six weeks postpartum further demonstrate the need for integrated follow-up strategies[34-38].

Overall, the current situation reflects a gap between the clinical impact of perinatal psychological disorders and the capacity of traditional care models to manage them effectively. The challenges emphasise the necessity of structured, continuous, and multidisciplinary systems to support affected women.

KEY ASPECTS OF MULTIDISCIPLINARY CLOSED LOOP CARE

A central element of this approach is the use of standardised psychological screening at several key stages. These stages include early pregnancy, mid pregnancy, late pregnancy, and the postpartum period. The authors report that women receiving closed loop care showed significant reductions in anxiety and depression scores at each stage when compared with those who received routine care. This finding demonstrates the value of timely identification and continuous monitoring of emotional wellbeing throughout the perinatal period.

Another important component is the delivery of targeted psychological interventions by trained professionals. These interventions include counselling sessions, emotional regulation techniques, and supportive communication. Shen et al[1] note that these measures helped stabilise emotional fluctuations, which contributed to smoother labour, fewer obstetric complications, and improved neonatal Apgar scores.

The model also relies on close cooperation among various clinical departments. Obstetricians, mental health specialists, midwives, and rehabilitation teams work together to ensure that psychological findings are communicated promptly. This cooperation allows clinical decisions to incorporate emotional health needs. The authors observe that this coordinated approach improved maternal cooperation during labour and shortened the duration of labour stages, which resulted in better delivery outcomes overall.

Structured follow up in the postpartum period is another essential feature. This includes guidance and support for pelvic floor recovery. Women in the closed loop group showed notably better pelvic floor function at six weeks postpartum. According to the authors, this improvement is likely due to greater emotional stability and increased adherence to rehabilitation advice.

Finally, the concept of a closed loop refers to a system that continuously gathers information at each stage and uses it to adjust subsequent care. This creates a personalised and responsive process rather than isolated and irregular interventions. The ongoing feedback cycle strengthens the effectiveness of treatment and promotes sustained improvement in maternal mental health. These elements demonstrate that multidisciplinary closed loop care offers a comprehensive and well-coordinated framework for improving maternal outcomes in women experiencing perinatal anxiety and depression.

KEY BENEFITS OF MULTIDISCIPLINARY CLOSED LOOP CARE

Improved delivery outcomes: Increased vaginal births and reduced caesarean sections

The multidisciplinary closed loop care model was associated with a meaningful reduction in caesarean section rates and improved vaginal delivery outcomes. Psychological support likely attenuated maternal stress responses that adversely affect labour physiology. Anxiety related activation of stress pathways can impair uterine contractility and prolong labour, whereas emotional stabilization may facilitate coordinated myometrial activity[39-41]. In this study, structured antenatal education addressing labour processes and delivery options, combined with emotional regulation training, improved maternal cooperation during labour. These interventions likely reduced fear driven tension, supported efficient labour progression, and decreased the need for operative delivery and perineal trauma[42].

Improved maternal and neonatal outcomes through risk reduction and enhanced safety

The intervention group demonstrated a lower incidence of combined maternal and neonatal adverse events. This improvement may be explained by enhanced maternal engagement in health promoting behaviours supported by multidisciplinary input[43]. Psychological counselling increased awareness of obstetric risks and encouraged active self-management, including monitoring of blood pressure and glucose levels, adherence to nutritional recommendations, appropriate gestational weight control, and participation in safe physical activity[44]. Coordinated care across obstetric, psychological, and rehabilitative services allowed early identification and mitigation of risks, thereby improving overall pregnancy safety[45-48].

Enhanced psychological wellbeing and pelvic floor functional recovery in the puerperium

Improved psychological wellbeing may support postpartum pelvic floor recovery through multiple interrelated mechanisms involving neuromuscular regulation and muscle tone modulation. Psychological state during the puerperium has been identified as a significant factor influencing pelvic floor functional recovery. In the present context, the superior pelvic floor muscle function observed at the 42 days postpartum assessment in the intervention group can be explained by a dual mechanism consisting of reduced baseline muscular tonicity and enhanced neuromuscular coordination[49,50].

Psychological distress, particularly anxiety, has been associated with pelvic floor dysfunction and related symptoms such as dyspareunia, urinary retention, and constipation. Sustained psychological support provided through the closed loop intervention, including stress management and relaxation training, likely promoted generalized muscle relaxation. This effect may be mediated through increased parasympathetic nervous system activity, which counterbalances sympathetic arousal and facilitates muscle release.

The observed reduction in pre and post rest surface electromyography values suggests a decrease in pelvic floor hypertonicity. By alleviating ischemia and pain associated with sustained muscle tension, a more favourable physiological environment for tissue healing and functional recovery may be established. Additionally, emotional stability achieved through continuous psychological support may reduce anxiety driven pelvic floor tension, indirectly supporting adherence to rehabilitation advice and effective neuromuscular activation during recovery[51,52]. Together, these psychobiological mechanisms provide a plausible explanation for the improved postpartum pelvic floor recovery observed in the intervention group[53-57].

APPLICATION OF MULTIDISCIPLINARY CLOSED LOOP CARE IN LOW RESOURCE AND CULTURALLY DIVERSE SETTINGS

The closed loop care model can be adapted to diverse healthcare contexts, including low resource community health centres, rural facilities, and regions with distinct cultural norms, by addressing the limitations of conventional perinatal mental health interventions. Although evidence-based strategies such as early prevention, systematic screening, interpersonal psychotherapy, cognitive behavioural therapy, and mindfulness-based approaches have demonstrated effectiveness in improving perinatal mental health, their real-world implementation often remains constrained by limited scalability, workforce shortages, and insufficient personalization.

In low resource and rural settings, the closed loop model provides a practical framework by integrating psychological screening and basic interventions into routine obstetric care. This approach reduces reliance on specialized mental health professionals and allows task sharing among obstetricians, nurses, midwives, and counsellors. The structured consultation, assessment, recommendation, support, and follow up cycle ensures continuity of care while maintaining individualized intervention through ongoing feedback.

In regions with distinct cultural norms related to perinatal mental health, the closed loop framework permits adaptation of counselling strategies and communication approaches to align with local beliefs and practices. Continuous assessment and feedback allow care plans to be modified according to patient response and cultural acceptability. Through coordinated multidisciplinary involvement and iterative care adjustment, the closed loop model offers a flexible and scalable approach that supports broader implementation across diverse healthcare systems and global clinical practice[58-60].

LIMITATIONS AND FUTURE DIRECTIONS

Although the multidisciplinary closed loop care model presented by Shen et al[1] offers promising results, several limitations should be considered when interpreting the findings. The study was conducted within a single hospital setting, which may restrict the generalisability of the results to wider populations with different healthcare structures or cultural contexts. The follow up period was limited to six weeks postpartum, which does not allow evaluation of long term maternal mental health outcomes or the durability of pelvic floor recovery. In addition, the study relied mainly on psychological scales that depend on self-reported measures. These assessments may be influenced by individual perception or social expectations. The authors also note that although multidisciplinary cooperation was implemented, variations in professional training and experience could influence the consistency of the interventions. Finally, the absence of biological or behavioural markers limits the ability to determine the precise mechanisms through which emotional improvement contributes to obstetric and neonatal outcomes.

CONCLUSION

The structured multidisciplinary closed loop care model proposed by Shen et al[1] demonstrates clear benefits in the management of perinatal anxiety and depression. The approach strengthens psychological screening, improves emotional stability across pregnancy, and enhances delivery outcomes and postpartum pelvic floor recovery when compared with routine care. The continuous cycle of assessment, intervention, and follow up ensures that emotional wellbeing is integrated into all stages of maternity care. Although further studies with broader populations and longer follow up periods are required, the findings support the clinical value of adopting coordinated and continuous mental health care within perinatal services. This model offers a practical and comprehensive method for improving the physical and emotional health of pregnant and postpartum women. In the present study, anxiety and depression severity were assessed using standardized Self-Rating Anxiety Scale and Self-Rating Depression Scale scores, which already support graded management. Within the multidisciplinary closed-loop model, interventions can be tailored according to symptom severity.

Women with mild symptoms may benefit primarily from early identification, structured education, group-based psychological support, stress management, and mindfulness-based strategies, which are supported by existing evidence for mild perinatal distress. For those with moderate to severe symptoms, the closed-loop framework allows escalation to more intensive and individualized psychological interventions, including frequent assessments, targeted counselling, and cognitive behavioural therapy, supported by close multidisciplinary monitoring.

The continuous screening, feedback, and follow-up inherent to the closed-loop structure enable dynamic adjustment of care based on symptom progression or improvement. This severity-based, adaptive approach enhances clinical utility for frontline providers and aligns with evidence supporting personalized and stepped-care models in perinatal mental health.