Identification and Therapy of Postpartum Depression

描述（由申请人提供）：围产期抑郁症是一个主要的公共卫生问题。产后抑郁症（PPD）在适应为人父母的关键时期给个人和家庭带来痛苦。在医疗环境中治疗抑郁症的成功干预措施已被慢性病管理模式所框定。成功的关键因素是一个专门的护理经理，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。与医疗办公室设置的干预措施相比，位于健康计划层面的电话护理管理为PPD妇女提供了一个系统和有效的持续治疗支持机制，特别是在地理上分散的人群中。我们建议开展一个综合项目，通过适应初级保健机构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效果。主要组成部分有：1)对产后妇女进行抑郁筛查；2)对所有筛查阳性的妇女进行抑郁教育；3)对筛查工具得分高于或低于规定阈值的妇女进行抑郁症诊断性访谈；4)对基于电话的护理管理干预与抑郁症常规护理进行随机对照试验；5)对产后第一年的抑郁症和母婴公共卫生结果进行纵向评估。参与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）获得心理健康服务。这两家公司都服务于医疗补助计划和商业会员。我们计划确定患有产后抑郁症的妇女（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。他们将在选择抑郁症治疗方面得到支持（在接受有关选择的教育之后），鼓励他们接受自己喜欢的治疗（通过直接讨论障碍和解决方案），建议他们遵守治疗建议，并在出现反应失败时协助他们解决问题。两组将在出生后3、6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。我们组建了一支多学科团队，在抑郁症和少数族裔妇女的临床研究和保健服务方面具有专业知识，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.