Identification and Therapy of Postpartum Depression

描述(申请人提供)：围产期抑郁是一个主要的公共卫生问题。产后抑郁症(PPD)会导致个人和家庭的痛苦，而此时适应为人父母是至关重要的。慢性病管理模式已经为在医疗环境中治疗抑郁症提供了成功的干预措施。成功的关键因素是一位敬业的护理经理，他为患者提供教育和支持，积极协调护理，从而改善患者的治疗结果。与医务室环境中的干预措施相比，定位在健康计划一级的电话护理管理提供了一种系统和有效的机制，为患有产后抑郁的妇女提供持续治疗支助，特别是在地理上分散的人口中。我们建议进行一个全面的项目，通过调整初级保健环境中使用的抑郁症护理管理模式来改善产后抑郁症妇女的治疗结果。主要部分包括：1)产后妇女群体中的抑郁症筛查；2)对筛查阳性的所有人进行抑郁症教育；3)诊断性访谈，以评估筛查仪器上得分高于和低于规定阈值的妇女的抑郁障碍；4)电话护理管理干预与常规护理的随机对照试验；以及5)产后第一年对抑郁症和母婴公共卫生结果的纵向评估。该项目的所有妇女都有资格通过两个健康计划(社区护理、行为健康组织和Highmark)获得精神健康服务。两家公司都为医疗补助和商业会员提供服务。我们计划确定患有产后抑郁的妇女(n=462)，她们同意被随机分配到抑郁症护理管理干预组或常规护理组。将支持他们作出关于抑郁症治疗的选择(在接受有关选择的教育之后)，鼓励他们获得他们喜欢的治疗(通过直接讨论障碍和解决方案)，咨询他们遵守治疗建议，并在没有反应的情况下帮助解决问题。两组都将在出生后3个月、6个月和12个月进行系统评估。结果不仅包括母亲抑郁症状水平，还包括母亲、家庭和婴儿的功能和公共卫生结果。我们已经建立了一支多学科团队，在抑郁症和少数族裔妇女的临床研究和卫生服务方面拥有专业知识，以满足这些需求。

DESCRIPTION (provided by applicant): Depression during the perinatal period is a major public health concern. Postpartum depression (PPD) causes personal and family suffering at a time when adaptation to parenthood is critical. Successful interventions for treating depression in medical settings have been framed by a chronic disease management model. The key ingredient to success is a dedicated care manager who provides education and support to patients, actively coordinates care, and thereby improves treatment outcomes for patients. Compared to interventions in medical office settings, telephone care management positioned at the level of the health plan offers a systematic and efficient mechanism for ongoing treatment support of women with PPD, particularly in a geographically dispersed population. We propose to conduct a comprehensive project to improve treatment outcomes for depressed postpartum women through adaptation of the depression care management model used in primary care settings. The major components are: 1) depression screening in a population of postpartum women, 2) depression education for all who screen positive, 3) a diagnostic interview to evaluate for depressive disorders in women who score above and below a defined threshold on the screening instrument, 4) a randomized controlled trial of telephone-based care management intervention vs. usual care for depression, and, 5) longitudinal evaluation across the first year post-birth for depression and maternal and child public health outcomes. All women in this project will be eligible for mental health services through two health plans (Community Care Behavioral Health Organization and Highmark). Both serve Medicaid and commercial members. We plan to identify women with PPD (n=462) who agree to be randomly assigned to the depression care management intervention or a usual care group. They will be supported in making choices about depression treatment (after receiving education about options), encouraged to access their preferred treatment (through the direct discussion of barriers and solutions), counseled to comply with treatment recommendations, and assisted to problem-solve if failure to respond occurs. Both groups will have systematic evaluations at 3, 6, and 12 months post-birth. Outcomes include not only maternal depressive symptom levels but also functional and public health outcomes for mothers, families, and infants. We have developed a multi-disciplinary team with expertise in clinical research with depressed and minority women and health services to address these needs.