Management of Maternal Depression in Primary Care

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DESCRIPTION (provided by applicant): The relationship between maternal depression and compromised child health outcomes is well-established. Despite this knowledge, many mothers suffering from depression go undiagnosed and untreated. Because obstetricians, pediatricians, and family medicine practitioners have contact with mothers of small children and often advise mothers on family interactions, wellbeing issues (e.g. maternal depression) that affect the family environment are highly relevant to their practice. Despite opportunity and relevance, many physicians do not currently diagnose and treat maternal depression. Thus, the present study proposes to survey pediatricians, obstetricians, and family medicine practitioners on their current attitudes, beliefs and practices toward the management of maternal depression, which in turn, will help design future innovative models that address barriers unique to the present locality, improving the overall management of maternal depression. The specific aims of the study are to 1) design a transportable web-based tool to assess physician attitudes, beliefs, and knowledge toward and practices in managing maternal depression; 2) examine barriers and facilitators at the systemic, practice, and physician levels for the effective management of maternal depression among primary care physicians; and 3) explore potential variation in these relationships among different primary care specialties (i.e. pediatrics, obstetrics, and family medicine). The study will involve 3 stages including survey content development, preliminary testing of the survey, and web-based survey implementation. An initial pool of survey items will be developed by the research team and then critiqued by an expert panel. The survey will then undergo preliminary testing in its web-based implementation. Once the web-based survey has been evaluated, all eligible physicians residing in the Hampton Roads Area of Southeastern Virginia will be sent an email and fax containing instructions for locating and browsing to the survey. The data collected from the survey will be analyzed for trends and patterns among specialties on current attitudes, beliefs, and practices toward managing maternal depression. Moreover, the new web-based tool will provide a strong multi-level assessment of barriers (i.e. physician, practice, and system) that will help design sensitive and targeted community-specific models to improve identification and management of maternal depression. We anticipate that the assessment-driven model that will be developed in the proposed study will be transportable to communities across the United States. Overall, the proposed study is designed to provide insight for future educational efforts to increase the knowledge base, enhance communication style, and address systemic barriers to increase detection rates of maternal depression in these specific practice settings. The proposed data collection effort will also afford an opportunity to be able to tailor future approaches to managing maternal depression based on unique local circumstances.