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 adolescents, 2) depression education for all who screen positive, 3) a diagnostic interview to evaluate for depressive disorders in mothers who score above and below a defined threshold on the screening instrument, 4) telephone-based care management intervention, and 5) longitudinal evaluation across the first year post-birth for depression and maternal and child public health outcomes. Focus groups will precede the major study components. A focus group of adolescent mothers will inform the investigators about the barriers to depression care management that encompass resource needs, acceptability of interventions to cope with stress or depression, and access to care. A separate focus group of community professionals of representatives from agencies or groups that provide community supports and health services will be used to explore the perceptions of barriers to care for new adolescent mothers. All participants in this project will be eligible for mental health services through their health plans that serve Medicaid and commercial members.
We plan to identify 125 child or adolescent new mothers with PPD. The child or adolescent new mothers will be assigned to depression care management. 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. All participants 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.
