Nancy K Grote1, Wayne J Katon2, Mary Jane Lohr3, Kathy Carson4, Mary Curran3, Erin Galvin3, Joan E Russo2, Marilyn Gregory3. 1. School of Social Work, University of Washington, Seattle, WA, USA. Electronic address: ngrote@u.washington.edu. 2. Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA. 3. School of Social Work, University of Washington, Seattle, WA, USA. 4. Public Health Seattle and King County (PHSKC), Seattle, WA, USA.
Abstract
BACKGROUND: Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS). METHODS:Pregnant, public health patients, >18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum). BASELINE RESULTS:168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making <$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy. CONCLUSIONS: A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study.
RCT Entities:
BACKGROUND:Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS). METHODS: Pregnant, public health patients, >18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum). BASELINE RESULTS: 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making <$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy. CONCLUSIONS: A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study.
Authors: Nomi S Weiss-Laxer; Rheanna Platt; Lauren M Osborne; Mary Kimmel; Barry S Solomon; Tamar Mendelson; Lindsey Webb; Anne W Riley Journal: Pediatr Res Date: 2015-10-20 Impact factor: 3.756
Authors: S Susan Hedayati; Divya M Daniel; Scott Cohen; Bryan Comstock; Daniel Cukor; Yaminette Diaz-Linhart; Laura M Dember; Amelia Dubovsky; Tom Greene; Nancy Grote; Patrick Heagerty; Wayne Katon; Paul L Kimmel; Nancy Kutner; Lori Linke; Davin Quinn; Tessa Rue; Madhukar H Trivedi; Mark Unruh; Steven Weisbord; Bessie A Young; Rajnish Mehrotra Journal: Contemp Clin Trials Date: 2015-11-24 Impact factor: 2.226
Authors: Catherine Chamberlain; Graham Gee; Stephen Harfield; Sandra Campbell; Sue Brennan; Yvonne Clark; Fiona Mensah; Kerry Arabena; Helen Herrman; Stephanie Brown Journal: PLoS One Date: 2019-03-13 Impact factor: 3.240
Authors: Nancy K Grote; Wayne J Katon; Joan E Russo; Mary Jane Lohr; Mary Curran; Erin Galvin; Kathy Carson Journal: Depress Anxiety Date: 2015-09-08 Impact factor: 6.505