Elsevier

Women's Health Issues

Volume 18, Issue 1, January–February 2008, Pages 44-52
Women's Health Issues

Article
Stepped Care Treatment of Postpartum Depression: A Primary Care-Based Management Model

https://doi.org/10.1016/j.whi.2007.09.001Get rights and content

Background and Purpose

Postpartum depression (PPD), the most prevalent serious postpartum complication, is a devastating illness that negatively impacts not only the mother, but also her infant, other family members, and work performance. There is an extensive body of research addressing systems-based quality improvement efforts for treatment of depression in primary care populations; however, little of this research has been directed toward postpartum populations. This paper presents a health care systems-based quality improvement model for the treatment of PPD derived from research outcomes in general primary care populations.

Methods

OVID/MEDLINE and PsychINFO searches were performed using the following terms: depression, postpartum depression, mass screening, collaborative care, stepped care, psychotherapy, cognitive–behavioral therapy, interpersonal therapy, and education as keywords.

Main Findings

The PPD management model described herein includes screening and diagnosis, initiation of active treatment, and use of collaborative care, which includes primary care visits, case manager follow-up, and more intensive care, through specialty consultation or referral, for complicated or difficult cases.

Conclusion

Stepped care, a form of collaborative depression treatment, is proposed as a practical, cost-effective method for improving PPD diagnosis and clinical outcomes.

Section snippets

Methods

The background for this paper was obtained by searching OVID/MEDLINE and PsychINFO, using the following terms as keywords: depression, postpartum depression, mass screening, collaborative care, stepped care, psychotherapy, cognitive–behavioral therapy, interpersonal therapy, and education. In addition, secondary searches were performed by reviewing references from key depression management papers.

Identifying PPD

For PPD to be appropriately treated, cases need to be accurately identified. Identification of PPD through standard postpartum care (which does not include routine formal screening) is typically poor, with diagnosis rates of 3.7% (Georgiopoulos et al., 2001) to 6.3% (Evins et al., 2000), half of the 10%–15% estimated prevalence of PPD (Gold, 2002). However, when routine screening is incorporated into postpartum care, diagnosis rates increase to 10.7% (based on diagnoses documented in medical

Conclusions

PPD affects 10%–15% of all postpartum women, creating a uniquely vulnerable population of both women and infants. Yet, none of the professional groups of providers who most often treat these women have established a standard of care that includes routine screening and early intervention. Borrowing on depression research in the general population, a stepped care model is proposed to identify and provide adequate treatment for these potential patients in the primary care setting. Elements of the

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    1

    Dwenda Gjerdingen, MD, MS, is a Professor in the Department of Family Medicine & Community Health at the University of Minnesota. She is a family physician provider and residency educator whose research is centered on postpartum depression and mothers’ and fathers’ postpartum health.

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    Wayne Katon, MD, is Professor of Psychiatry, Director of the Division of Health Services and Epidemiology, and Vice Chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical School. Dr. Katon is internationally renowned for his research on the prevalence of anxiety and depressive disorders in primary care, the impact of depression and anxiety on patients with chronic medical illness, and the development of innovative models that integrate mental health and other allied health professionals into primary care to improve the care of patients with major depression and panic disorder.

    3

    Deborah Rich, PhD, LP, is Coordinator of Perinatal Loss and Perinatal Depression Services at Fairview Health Systems in Minneapolis, Minnesota. She is a counseling psychologist and educator specializing in Reproductive Health Psychology. She also maintains a private practice in St. Paul, MN.

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