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Guille C, King C, King K, Kruis R, Ford D, Maldonado L, Nietert PJ, Brady KT, Newman RB. Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions. Health Aff (Millwood) 2024; 43:548-556. [PMID: 38560794 DOI: 10.1377/hlthaff.2023.01432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Effective screening and referral practices for perinatal mental health disorders, perinatal substance use disorders (SUDs), and intimate partner violence are greatly needed to reduce maternal morbidity and mortality. We conducted a randomized controlled trial from January 2021 to April 2023 comparing outcomes between Listening to Women and Pregnant and Postpartum People (LTWP), a text- and telephone-based screening and referral program, and usual care in-person screening and referral within the perinatal care setting. Participants assigned to LTWP were three times more likely to be screened compared with those assigned to usual care. Among participants completing a screen, those assigned to LTWP were 3.1 times more likely to screen positive, 4.4 times more likely to be referred to treatment, and 5.7 times more likely to attend treatment compared with those assigned to usual care. This study demonstrates that text- and telephone-based screening and referral systems may improve rates of screening, identification, and attendance to treatment for perinatal mental health disorders and perinatal SUDs compared with traditional in-person screening and referral systems. System-level changes and complementary policies and insurance payments to support adoption of effective text- and telephone-based screening and referral programs are needed.
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Affiliation(s)
- Constance Guille
- Constance Guille , Medical University of South Carolina, Charleston, South Carolina
| | | | - Kathryn King
- Kathryn King, Medical University of South Carolina
| | - Ryan Kruis
- Ryan Kruis, Medical University of South Carolina
| | - Dee Ford
- Dee Ford, Medical University of South Carolina
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Faherty LJ, Gwokyalya V, Dickens A, McBain R, Ngo V, Nakigudde J, Nakku J, Mukasa B, Beyeza-Kashesya J, Wanyenze RK, Wagner GJ. Treatment of Perinatal Depression and Correlates of Treatment Response Among Pregnant Women Living with HIV in Uganda. Matern Child Health J 2023; 27:2017-2025. [PMID: 37354364 PMCID: PMC10564822 DOI: 10.1007/s10995-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Perinatal depression is common among women living with HIV, but depression care is limited in low-resource settings. We examined (1) characteristics of women receiving Problem Solving Therapy (PST) versus antidepressant therapy (ADT), (2) treatment response by modality, and (3) correlates of treatment response. METHODS This analysis used data from 191 Ugandan women in the intervention arm of a cluster randomized controlled trial of task-shifted, stepped-care depression treatment for pregnant women living with HIV (PWLWH). Treatment response was defined as scoring < 5 on the nine-item Patient Health Questionnaire (PHQ-9). Bivariate analysis and multivariable logistic regression were used to examine characteristics of women by treatment group and correlates of treatment response. RESULTS Of 134 participants with depression, 129 (96%) were treated: 84 (65%) received PST and 45 (35%) received ADT. Severe depression at treatment initiation was more common in those receiving ADT (28.9% versus 4.8%, Fischer's Exact Test < 0.001). Treatment response was higher for PST (70/84; 83.3%) than ADT (30/45; 66.7%; p = .03). ADT side effects were rare and minor; no infants had serious congenital defects. Of 22 participants (19%) who did not respond to treatment, only five received intensified management. Social support and interpersonal violence were associated with treatment response (adjusted odds ratio, [aOR] = 3.06, 95% CI = 1.08-8.66 and aOR = 0.64, 95% CI = 0.44-0.93). DISCUSSION Both depression treatment modalities yielded high response rates in Ugandan PWLWH; ADT was well-tolerated. Our results highlight a need to build capacity to implement the stepped-care protocol for non-responders and screen for social support and interpersonal violence.
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Affiliation(s)
- Laura J Faherty
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02128, USA.
- Department of Pediatrics, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.
| | | | - Akena Dickens
- Makerere University, 7062 University Rd, Kampala, Uganda
| | - Ryan McBain
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02128, USA
| | - Vicky Ngo
- Graduate School of Public Health and Health Policy, City University of New York, 205 E 42nd St, New York, NY, 10017, USA
| | | | - Juliet Nakku
- Makerere University, 7062 University Rd, Kampala, Uganda
| | | | | | | | - Glenn J Wagner
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA
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3
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Wagner GJ, Ghosh-Dastidar B, Faherty L, Beyeza-Kashesya J, Nakku J, Nabitaka LK, Akena D, Nakigudde J, Ngo V, McBain R, Lukwata H, Gwokyalya V, Mukasa B, Wanyenze RK. Effects of M-DEPTH Model of Depression Care on Maternal Functioning and Infant Developmental Outcomes in the Six Months Post Delivery: Results from a Cluster Randomized Controlled Trial. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2023; 11:313-328. [PMID: 39081835 PMCID: PMC11286218 DOI: 10.1080/23293691.2023.2255587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/13/2023] [Indexed: 08/02/2024]
Abstract
Perinatal depression has been shown to have deleterious effects on maternal post-partum functioning, as well as early child development. However, few studies have documented whether depression care helps to mitigate these effects. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on maternal functioning and infant development in the first 6 months post-delivery in an ongoing cluster randomized controlled trial of 391 HIV-infected women with at least mild depressive symptoms enrolled across eight antenatal care clinics in Uganda. A subsample of 354 (177 in each of the intervention and control groups) had a live birth delivery and comprised the analytic sample, of whom 69% had clinical depression at enrollment; 70% of women in the intervention group (including 96% of those with clinical depression) received depression treatment. Repeated-measures multivariable regression models found that the intervention group reported better infant care, lower parental burden, and greater perceived adequacy of parental support, compared to the control group. These findings suggest that depression care for pregnant women living with HIV is important not only for maternal mental health, but it also helps women to better manage parenting and care for their infant.
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Affiliation(s)
| | | | - Laura Faherty
- RAND Corporation, Santa Monica, CA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Jolly Beyeza-Kashesya
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Makerere University, School of Medicine, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, Kampala Uganda
| | | | - Dickens Akena
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Ngo
- RAND Corporation, Santa Monica, CA, USA
- City University of New York, Graduate School of Public Health and Health Policy, NY, USA
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Wagner GJ, Gwokyalya V, Faherty L, Akena D, Nakigudde J, Ngo V, McBain R, Ghosh-Dastidar B, Beyeza-Kashesya J, Nakku J, Kyohangirwe L, Nabitaka LK, Lukwata H, Mukasa B, Wanyenze RK. Effects of M-DEPTH Model of Depression Care on Maternal HIV Viral Suppression and Adherence to the PMTCT Care Continuum Among HIV-Infected Pregnant Women in Uganda: Results from a Cluster Randomized Controlled Trial at Pregnancy Completion. AIDS Behav 2023; 27:2902-2914. [PMID: 36907945 PMCID: PMC10386969 DOI: 10.1007/s10461-023-04014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 03/14/2023]
Abstract
Perinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the prevention of mother-to-child transmission (PMTCT) care continuum; therefore, treating perinatal depression may result in increased viral suppression and PMTCT adherence. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on depression, maternal viral suppression and adherence to PMTCT care processes in an ongoing cluster-randomized controlled trial of 391 HIV-infected pregnant women (200 usual care; 191 intervention) with at least mild depressive symptoms enrolled across 8 antenatal care clinics in Uganda. At baseline, 68.3% had clinical depression and 41.7% had detectable HIV viral load. Adjusted repeated-measures multivariable regression models found that the intervention group was nearly 80% less likely to be clinically depressed [Adjusted OR (95% CI) 0.22 (0.05, 0.89)] at the 2-month post-pregnancy assessment, compared to the control group. However, the intervention and control groups did not differ meaningfully on maternal viral suppression, ART adherence, and other PMTCT care processes and outcomes. In this sample of women who were mostly virally suppressed and ART adherent at baseline, the depression care model had a strong effect on depression alleviation, but no downstream effects on viral suppression or other PMTCT care processes.Trial Registration NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - Laura Faherty
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Dickens Akena
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Ngo
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- City University of New York, Graduate School of Public Health and Health Policy, New York, USA
| | - Ryan McBain
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Jolly Beyeza-Kashesya
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Makerere University, School of Medicine, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, Kampala, Uganda
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Vanderkruik R, Freeman MP, Nonacs R, Jellinek M, Gaw ML, Clifford CA, Bartels S, Cohen LS. To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening. Gen Hosp Psychiatry 2023; 83:81-85. [PMID: 37141774 DOI: 10.1016/j.genhosppsych.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation "against instrument-based depression screening using a questionnaire with cut-off score to distinguish 'screen positive' and 'screen negative' administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth)." While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for "de-implementation" of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.
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Affiliation(s)
- Rachel Vanderkruik
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA.
| | - Marlene P Freeman
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
| | - Ruta Nonacs
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
| | | | - Margaret L Gaw
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America
| | - Charlotte A Clifford
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America
| | - Stephen Bartels
- Harvard Medical School, Boston, MA, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lee S Cohen
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
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Allen EC, Sakowicz A, Parzyszek CL, McDonald A, Miller ES. The association between engagement in a perinatal collaborative care program and breastfeeding among people with identified mental health conditions. Am J Obstet Gynecol MFM 2022; 4:100591. [DOI: 10.1016/j.ajogmf.2022.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
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Weigel G, Frederiksen B, Ranji U, Salganicoff A. Screening and Intervention for Psychosocial Needs by U.S. Obstetrician-Gynecologists. J Womens Health (Larchmt) 2022; 31:887-894. [PMID: 34995169 DOI: 10.1089/jwh.2021.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To determine the psychosocial needs screening and intervention practices of obstetrician-gynecologists (OBGYNs) and elucidate characteristics associated with screening and resource availability. Methods: We administered a cross-sectional paper and online survey to 6288 U.S. office-based OBGYNs from March 18 to September 1, 2020, inquiring about screening and intervention practices for intimate partner violence, depression, housing, and transportation. We analyzed associations between demographic/practice characteristics and screening/having resources for all four needs. Results: 1210 OBGYNs completed the survey. One hundred ninety-five OBGYNs (16%) reported their practices screened all patients for all four needs. Having resources to address all four needs (prevalence ratio [PR] = 4.39, 95% confidence interval [CI] = 3.04-6.34), working in health centers/clinics (PR = 2.22, 95% CI = 1.43-3.45), and seeing ≥50% Medicaid patients (PR = 1.62, 95% CI = 1.02-2.58) were associated with screening for all four needs. One hundred sixty-eight OBGYNs (14%) reported their practices had resources onsite to address all four needs. Working in health centers/clinics (PR = 3.99, 95% CI = 2.56-6.22), large practices (PR = 3.37, 95% CI = 1.63-6.95), Medicaid expansion states (PR = 2.60, 95% CI = 1.45-4.65), and practices with >11% uninsured patients (PR 2.30, 95% CI = 1.31-4.04) were associated with having resources onsite for all four needs. Conclusion: Most OBGYN practices appeared underresourced to address psychosocial needs within clinical care. Innovative financial models or collaborative care models may help incentivize this work.
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Affiliation(s)
- Gabriela Weigel
- University of California, San Francisco School of Medicine, San Francisco, California, USA
| | | | - Usha Ranji
- The Henry J. Kaiser Family Foundation (KFF), San Francisco, California, USA
| | - Alina Salganicoff
- The Henry J. Kaiser Family Foundation (KFF), San Francisco, California, USA
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Schipani Bailey E, Byatt N, Carroll S, Brenckle L, Sankaran P, Kroll-Desrosiers A, Smith NA, Allison J, Simas TAM. Results of a Statewide Survey of Obstetric Clinician Depression Practices. J Womens Health (Larchmt) 2021; 31:675-681. [PMID: 34491103 PMCID: PMC9133971 DOI: 10.1089/jwh.2021.0147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Perinatal depression affects upwards of one in seven women and is associated with significant negative maternal and child consequences. Despite this, it remains under-detected and under-treated. We sought to identify clinician practices, self-efficacy, and remaining barriers to comprehensively addressing perinatal depression care. Materials and Methods: Surveys were administered to obstetric clinicians in Massachusetts that queried frequency of depression screening and Likert questions about subsequent depression management. Results: Approximately 79.0% of clinicians approached completed the survey. Whereas most clinicians (93.5%) screened for perinatal depression at 6 weeks postpartum, fewer clinicians (66.1%) screened during pregnancy. Most reported they were comfortable providing support to their patients (98.4%), but fewer endorsed being able to treat them on their own (43.0%). Most noted an ability to treat with antidepressants (77.9%); however, fewer endorsed adequate access to nonmedication treatment (45.5%). Conclusions: The majority of surveyed clinicians screen for depression consistent with guidelines. However, efforts are focused on the postpartum period, despite literature citing two-thirds of patients experiencing onset before or during pregnancy. Respondents indicated an ability to treat with medication management, while noting greater challenge with referral. These findings describe the challenges of interdisciplinary coordination as a barrier to comprehensive perinatal mental health care. Clinical Trial Registration Number: NCT02760004.
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Affiliation(s)
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Smita Carroll
- Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Linda Brenckle
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Padma Sankaran
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Aimee Kroll-Desrosiers
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Massachusetts Memorial Healthcare, Worcester, Massachusetts, USA
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Myers BA, Pillay Y, Guyton Hornsby W, Shubrook J, Saha C, Mather KJ, Fitzpatrick K, de Groot M. Recruitment effort and costs from a multi-center randomized controlled trial for treating depression in type 2 diabetes. Trials 2019; 20:621. [PMID: 31694682 PMCID: PMC6836437 DOI: 10.1186/s13063-019-3712-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Participant recruitment for clinical trials is a significant challenge for the scientific research community. Federal funding agencies have made continuation of funding of clinical trials contingent on meeting recruitment targets. It is incumbent on investigators to carefully set study recruitment timelines and resource needs to meet those goals as required under current funding mechanisms. This paper highlights the cost, labor, and barriers to recruitment for Program ACTVE II, a successful multisite randomized controlled trial of behavioral treatments for depression in adults with type 2 diabetes, conducted in rural and urban settings in three states. Methods Quantitative and qualitative data on recruitment were gathered from study staff throughout the study recruitment period and were used to calculate costs and effort. The study utilized two main approaches to recruitment: (1) relying on potential participants to see ads in the community and call a toll-free number; and (2) direct phone calls to potential participants by study staff. Results Contact was attempted with 18,925 people to obtain the enrolled sample of 140. The cost of recruitment activities during the 4.5-year recruitment period totaled $190,056, an average cost of $1358 per enrolled participant. Qualitative evaluations identified multiple barriers to recruitment. Conclusions Recruitment for Program ACTIVE II exemplifies the magnitude of resources needed to reach recruitment targets in the current era. Continuous evaluation, flexibility, and adaptation are required on the part of investigators, community partners, and funding agencies to successfully reach high-risk populations in rural and urban areas. Trial registration ClinicalTrials.gov, NCT03371940. Registered on 13 December 2017.
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Affiliation(s)
- Barbara A Myers
- Indiana University School of Medicine, Diabetes Translational Research Center, 410 W 10th St, Suite 3100, Indianapolis, IN, 46202, USA
| | - Yegan Pillay
- Patton College of Education, Ohio University, McCracken Hall 432M, Athens, OH, 45701, USA
| | - W Guyton Hornsby
- West Virginia University School of Medicine, PO Box 9227, 8316 HSS, Morgantown, WV, 26506, USA
| | - Jay Shubrook
- College of Osteopathic Medicine, Touro University California, 1310 Club Dr, Vallejo, CA, 94592, USA
| | - Chandan Saha
- Indiana University School of Medicine, Diabetes Translational Research Center, 410 W 10th St, Suite 3100, Indianapolis, IN, 46202, USA
| | - Kieren J Mather
- Indiana University School of Medicine, Diabetes Translational Research Center, 410 W 10th St, Suite 3100, Indianapolis, IN, 46202, USA
| | - Karen Fitzpatrick
- West Virginia University School of Medicine, PO Box 9227, 8316 HSS, Morgantown, WV, 26506, USA
| | - Mary de Groot
- Indiana University School of Medicine, Diabetes Translational Research Center, 410 W 10th St, Suite 3100, Indianapolis, IN, 46202, USA.
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Powers A, Woods-Jaeger B, Stevens JS, Bradley B, Patel MB, Joyner A, Smith AK, Jamieson DJ, Kaslow N, Michopoulos V. Trauma, psychiatric disorders, and treatment history among pregnant African American women. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 12:138-146. [PMID: 31464464 DOI: 10.1037/tra0000507] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. METHOD The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. RESULTS Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. CONCLUSION Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Wagner GJ, McBain RK, Akena D, Ngo V, Nakigudde J, Nakku J, Chemusto H, Beyeza-Kashesya J, Gwokyalya V, Faherty LJ, Kyohangirwe L, Nabitaka LK, Lukwata H, Linnemayr S, Ghosh-Dastidar B, Businge J, Mukasa B, Wanyenze RK. Maternal depression treatment in HIV (M-DEPTH): Study protocol for a cluster randomized controlled trial. Medicine (Baltimore) 2019; 98:e16329. [PMID: 31277180 PMCID: PMC6635242 DOI: 10.1097/md.0000000000016329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Over one-third of human immunodeficiency virus (HIV)-infected pregnant women are clinically depressed, increasing the risk of mother-to-child transmission (MTCT) of HIV, as well as negative birth and child development outcomes. This study will evaluate the efficacy and cost-effectiveness of an evidence-based stepped care treatment model for perinatal depression (maternal depression treatment in HIV [M-DEPTH]) to improve adherence to prevention of MTCT care among HIV+ women in Uganda. METHODS Eight antenatal care (ANC) clinics in Uganda will be randomized to implement either M-DEPTH (n=4) or usual care (n=4) for perinatal depression among 400 pregnant women (n=50 per clinic) between June 2019 and August 2022. At each site, women who screen positive for potential depression will be enrolled and followed for 18 months post-delivery, assessed in 6-month intervals: baseline, within 1 month of child delivery or pregnancy termination, and months 6, 12, and 18 following delivery. Primary outcomes include adherence to the prevention of mother-to-child transmission (PMTCT) care continuum-including maternal antiretroviral therapy and infant antiretrovial prophylaxis, and maternal virologic suppression; while secondary outcomes will include infant HIV status, post-natal maternal and child health outcomes, and depression treatment uptake and response. Repeated-measures multivariable regression analyses will be conducted to compare outcomes between M-DEPTH and usual care, using 2-tailed tests and an alpha cut-off of P <.05. Using a micro-costing approach, the research team will relate costs to outcomes, examining the incremental cost-effectiveness ration (ICER) of M-DEPTH relative to care as usual. DISCUSSION This cluster randomized controlled trial will be one of the first to compare the effects of an evidence-based depression care model versus usual care on adherence to each step of the PMTCT care continuum. If determined to be efficacious and cost-effective, this study will provide a model for integrating depression care into ANC clinics and promoting adherence to PMTCT. TRIAL REGISTRATION NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).
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Affiliation(s)
| | | | | | - Victoria Ngo
- RAND Corporation, Santa Monica, CA
- City University of New York Graduate School of Public Health and Health Policy, New York, NY
| | | | | | | | | | | | - Laura J. Faherty
- RAND Corporation, Santa Monica, CA
- Boston University School of Medicine, Boston, MA
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Depresión en el embarazo. ACTA ACUST UNITED AC 2019; 48:58-65. [DOI: 10.1016/j.rcp.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/15/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
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Byatt N, Moore Simas TA, Biebel K, Sankaran P, Pbert L, Weinreb L, Ziedonis D, Allison J. PRogram In Support of Moms (PRISM): a pilot group randomized controlled trial of two approaches to improving depression among perinatal women. J Psychosom Obstet Gynaecol 2018; 39:297-306. [PMID: 28994626 PMCID: PMC5893445 DOI: 10.1080/0167482x.2017.1383380] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE This pilot study was designed to inform a larger effectiveness trial by: (1) assessing the feasibility of the PRogram In Support of Moms (PRISM) and our study procedures; and, (2) determining the extent to which PRISM as compared to an active comparison group, the Massachusetts Child Access Psychiatry Program (MCPAP) for Moms alone, improves depression among perinatal women. METHODS Four practices were randomized to either PRISM or MCPAP for Moms alone, a state-wide telephonic perinatal psychiatry program. PRISM includes MCPAP for Moms plus implementation assistance with local champions, training, and implementation of office prompts and procedures to enhance depression screening, assessment and treatment. Patients with Edinburgh Postnatal Depression Scales (EPDS) ≥ 10 were recruited during pregnancy, and completed the EPDS and a structured interview at baseline and 3-12 weeks' postpartum. RESULTS Among MCPAP for Moms alone practices, patients' (n = 9) EPDS scores improved from 15.22 to 10.11 (p = 0.010), whereas in PRISM practices patients' (n = 21) EPDS scores improved from 13.57 to 6.19 (p = 0.001); the between groups difference-of-differences was 2.27 (p = 0.341). CONCLUSIONS PRISM was beneficial for patients, clinicians, and support staff. Both PRISM and MCPAP for Moms alone improve depression symptom severity and the percentage of women with an EPDS >10. The improvement difference between groups was not statistically significant due to limited power associated with small sample size.
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Affiliation(s)
- Nancy Byatt
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Tiffany A. Moore Simas
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Kathleen Biebel
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Padma Sankaran
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Lori Pbert
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Linda Weinreb
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jeroan Allison
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
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Bhat A, Reed S, Mao J, Vredevoogd M, Russo J, Unger J, Rowles R, Unützer J. Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness. J Psychosom Obstet Gynaecol 2018; 39:273-280. [PMID: 28882096 PMCID: PMC6203656 DOI: 10.1080/0167482x.2017.1367381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. METHODS We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. RESULTS The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Susan Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Johnny Mao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Mindy Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jennifer Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Roger Rowles
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA,Generations Obstetrics and Gynecology, Yakima, WA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Fedock GL, Alvarez C. Differences in Screening and Treatment for Antepartum Versus Postpartum Patients: Are Providers Implementing the Guidelines of Care for Perinatal Depression? J Womens Health (Larchmt) 2018; 27:1104-1113. [DOI: 10.1089/jwh.2017.6765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gina L. Fedock
- University of Chicago, School of Social Service Administration, Chicago, Illinois
| | - Carmen Alvarez
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Sanchez K, Eghaneyan BH, Killian MO, Cabassa L, Trivedi MH. Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial. Trials 2017; 18:363. [PMID: 28774339 PMCID: PMC5543442 DOI: 10.1186/s13063-017-2109-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up. Methods We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies. Discussion This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities. Trial registration ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2109-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Michael O Killian
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Leopoldo Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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18
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Hypoestrogenism alters mood: Ketamine reverses depressive-like behavior induced by ovariectomy in rats. Pharmacol Rep 2016; 68:109-15. [DOI: 10.1016/j.pharep.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 01/22/2023]
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Olin SCS, Kerker B, Stein REK, Weiss D, Whitmyre ED, Hoagwood K, Horwitz SM. Can Postpartum Depression Be Managed in Pediatric Primary Care? J Womens Health (Larchmt) 2015; 25:381-90. [PMID: 26579952 DOI: 10.1089/jwh.2015.5438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Postpartum depression is prevalent among women who have had a baby within the last 12 months. Depression can compromise parenting practices, child development, and family stability. Effective treatments are available, but access to mental healthcare is challenging. Routine infant healthcare visits represent the most regular contact mothers have with the healthcare system, making pediatric primary care (PPC) an ideal venue for managing postpartum depression. METHODS We conducted a review of the published literature on postpartum depression programs. This was augmented with a Google search of major organizations' websites to identify relevant programs. Programs were included if they focused on clinical care practices, for at-risk or depressed women during the first year postpartum, which were delivered within the primary care setting. RESULTS We found that 18 programs focused on depression care for mothers of infants; 12 were developed for PPC. All programs used a screening tool. Psychosocial risk assessments were commonly used to guide care strategies, which included brief counseling, motivating help seeking, engaging social supports, and facilitating referrals. Available outcome data suggest the importance of addressing postpartum depression within primary care and providing staff training and support. The evidence is strongest in family practices and community-based health settings. More outcome data are needed in pediatric practices. CONCLUSION Postpartum depression can be managed within PPC. Psychosocial strategies can be integrated as part of anticipatory guidance. Critical supports for primary care clinicians, especially in pediatric practices, are needed to improve access to timely nonstigmatizing care.
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Affiliation(s)
- Su-Chin Serene Olin
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Bonnie Kerker
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Ruth E K Stein
- 2 Albert Einstein College of Medicine/Children's Hospital at Montefiore , Bronx, New York
| | - Dara Weiss
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Emma D Whitmyre
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Kimberly Hoagwood
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Sarah M Horwitz
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
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Poleshuck E, Wittink M, Crean H, Gellasch T, Sandler M, Bell E, Juskiewicz I, Cerulli C. Using patient engagement in the design and rationale of a trial for women with depression in obstetrics and gynecology practices. Contemp Clin Trials 2015; 43:83-92. [PMID: 25937505 DOI: 10.1016/j.cct.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Significant health disparities exist among socioeconomically disadvantaged women, who experience elevated rates of depression and increased risk for poor depression treatment engagement and outcomes. We aimed to use stakeholder input to develop innovative methods for a comparative effectiveness trial to address the needs of socioeconomically disadvantaged women with depression in women's health practices. METHODS Using a community advisory board, focus groups, and individual patient input, we determined the feasibility and acceptability of an electronic psychosocial screening and referral tool; developed and finalized a prioritization tool for women with depression; and piloted the prioritization tool. Two intervention approaches, enhanced screening and referral using an electronic psychosocial screening, and mentoring using the prioritization tool, were developed as intervention options for socioeconomically disadvantaged women attending women's health practices. We describe the developmental steps and the final design for the comparative effectiveness trial evaluating both intervention approaches. CONCLUSIONS Stakeholder input allowed us to develop an acceptable clinical trial of two patient-centered interventions with patient-driven outcomes.
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Affiliation(s)
- Ellen Poleshuck
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA; Department of Obstetrics and Gynecology, University of Rochester, 401 Elmwood Ave, Rochester, NY 14642, USA.
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Hugh Crean
- School of Nursing, University of Rochester, 255 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Tara Gellasch
- Newark Wayne, Rochester Regional Health System, 1200 Driving Park Avenue, Newark, NY 14513, USA
| | - Mardy Sandler
- Division of Social Work, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Elaine Bell
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Iwona Juskiewicz
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642, USA
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Abstract
BACKGROUND The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period. METHODS Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well. RESULTS A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting. CONCLUSIONS Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.
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Improving care for depression in obstetrics and gynecology: a randomized controlled trial. Obstet Gynecol 2014; 123:1237-1246. [PMID: 24807320 DOI: 10.1097/aog.0000000000000231] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate an evidence-based collaborative depression care intervention adapted to obstetrics and gynecology clinics compared with usual care. METHODS A two-site, randomized controlled trial included screen-positive women (Patient Health Questionnaire-9 score of at least 10) who met criteria for major depression, dysthymia, or both (Mini-International Neuropsychiatric Interview). Women were randomized to 12 months of collaborative depression management or usual care; 6-month, 12-month, and 18-month outcomes were compared. The primary outcomes were change from baseline to 12 months in depression symptoms and functional status. Secondary outcomes included at least 50% decrease and remission in depressive symptoms, global improvement, treatment satisfaction, and quality of care. RESULTS Participants were, on average, 39 years old, 44% were nonwhite, and 56% had posttraumatic stress disorder. Intervention (n=102) compared with usual care (n=103) patients had greater improvement in depressive symptoms at 12 months (P<.001) and 18 months (P=.004). The intervention group compared with usual care group had improved functioning over the course of 18 months (P<.05), were more likely to have at least 50% decrease in depressive symptoms at 12 months (relative risk [RR] 1.74, 95% confidence interval [CI] 1.11-2.73), greater likelihood of at least four specialty mental health visits (6-month RR 2.70, 95% CI 1.73-4.20; 12-month RR 2.53, 95% CI 1.63-3.94), adequate dose of antidepressant (6-month RR 1.64, 95% CI 1.03-2.60; 12-month RR 1.71, 95% CI 1.08-2.73), and greater satisfaction with care (6-month RR 1.70, 95% CI 1.19-2.44; 12-month RR 2.26, 95% CI 1.52-3.36). CONCLUSION Collaborative depression care adapted to women's health settings improved depressive and functional outcomes and quality of depression care. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01096316. LEVEL OF EVIDENCE I.
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Abstract
OBJECTIVE To describe the presenting symptoms of women with depression in two obstetrics and gynecology clinics, determine depression diagnosis frequency, and examine factors associated with depression diagnosis. METHODS Data were extracted from charts of women screening positive for depression in a clinical trial testing a collaborative care depression intervention. Bivariate and multivariable analyses examined patient factors associated with the diagnosis of depression by an obstetrician-gynecologist (ob-gyn). RESULTS Eleven percent of women with depression presented with a psychologic chief complaint but another 30% mentioned psychologic distress. All others noted physical symptoms only or presented for preventive care. Ob-gyns did not identify 60% of women with a depression diagnosis. Depression severity was similar in women who were or were not diagnosed by their ob-gyns. Bivariate analyses showed four factors significantly associated with depression diagnosis: reporting a psychologic symptom as the chief complaint or associated symptom (72% compared with 18.6%, P<.001), younger age (35.5 years compared with 40.8 years, P<.005), being within 12 months postpartum (13.9% compared with 2.8%, P<.005), and a primary care-oriented visit (72% compared with 30%, P<.001). Multivariable analysis showed that reporting a psychologic symptom (adjusted odds ratio [OR] 8.90, 95% confidence interval [CI] 4.15-19.10, P<.001), a primary care oriented visit (adjusted OR 2.46, 95% CI 1.14-5.29, P=.03), and each year of increasing age (adjusted OR 0.96, 95% CI 0.93-0.96, P=.02) were significantly associated with a depression diagnosis. CONCLUSION The majority of women with depression presented with physical symptoms; most women with depression were not diagnosed by their ob-gyn, and depression severity was similar in those diagnosed and those not diagnosed. LEVEL OF EVIDENCE III.
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