Study is first to show improved outcomes with postpartum depression screening and care
Studies have shown that maternal postpartum depression (PPD) affects one in every 5 to 6 postpartum women, but is often undetected and if recognized, undertreated. A new practice-based research network study compared a system of screening, supported diagnosis, and PPD management within family medicine practices to usual care. The new approach significantly increased rates of PPD recognition, treatment, and fewer depressive symptoms at 12 months.
The researchers randomly assigned 14 family medicine practices to usual care and 14 to the intervention. Intervention practices received education and tools for postpartum depression screening, diagnosis, and therapy initiation, and care systems to encourage patient followup, which occurred within each practice. Usual-care practices received a 30-minute presentation about postpartum depression.
Of the 2,343 women enrolled shortly after giving birth, 1,897 (80.1 percent) provided outcome information and were included in the analysis. They were mailed packets that included two depression screening tools (the Edinburgh Postnatal Depression Scale and the 9-item Patient Health Questionnaire, PHQ-9), plus assessments related to parenting and partner relationships to complete and return to the central site at intake (baseline), 6 months, and 12 months later.
Elevated screening scores, indicating high risk for depression, were noted for 34.5 percent (654) of women—255 at usual care practices and 399 at intervention practices. Baseline PHQ-9 scores consistent with moderate to severe depression were found for 5.1 percent of usual-care women and 5.6 percent of intervention women.
At the end of 12-months followup, intervention group women were significantly more likely to receive a diagnosis and therapy for postpartum depression. Also, women in the intervention group with initially elevated depression scores were 74 percent more likely to show a clinically significant drop in depression compared with those from the usual-care group. Worthy of note is the modest amount of additional time required in the intervention practices. The study was funded by the Agency for Healthcare Research and Quality (HS14774).
More details are in "TRIPPD: A practice-based network effectiveness study of postpartum depression screening and management," by Barbara P. Yawn, MD, M.Sc., Allen J. Dietrich, MD, Peter Wollan, PhD, and others in the July/August 2012 Annals of Family Medicine 10(4), pp. 320-329.
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