Identification and Therapy of Postpartum Depression

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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.