RT Journal Article
SR Electronic
T1 TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 320
OP 329
DO 10.1370/afm.1418
VO 10
IS 4
A1 Barbara P. Yawn
A1 Allen J. Dietrich
A1 Peter Wollan
A1 Susan Bertram
A1 Debbie Graham
A1 Jessica Huff
A1 Margary Kurland
A1 Suzanne Madison
A1 Wilson D. Pace
A1 In collaboration with the TRIPPD practices
YR 2012
UL http://www.annfammed.org/content/10/4/320.abstract
AB PURPOSE Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression in postpartum mothers. METHODS In this practice-based effectiveness study, 28 practices were randomized to usual care (n = 14) or intervention (n = 14), and 2,343 women were enrolled between 5 and 12 weeks’ postpartum. The intervention sites received education and tools for postpartum depression screening, diagnosis, initiation of therapy, and follow-up within their practices. Usual-care practices received a 30-minute presentation about postpartum depression. Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care. Outcomes were based on patient-reported outcomes (level of depressive symptoms) from surveys at 6 and 12 months, plus medical record review (diagnosis and therapy initiation). RESULTS Among the 2,343 women enrolled, 1,897 (80.1%) provided outcome information, and were included in the analysis. Overall, 654 (34.5% of 1,897) women had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 (P = .07) and 12 months’ (P=.001) postpartum. CONCLUSIONS Primary care–based screening, diagnosis, and management improved mother’s depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.