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Stepped Care Treatment of Postpartum Depression: Impact on Treatment, Health, and Work Outcomes

Department of Family Medicine and Community Health (DG, MM, BC), University of Minnesota, St. Paul
Department of Psychiatry (SC), University of Minnesota, St. Paul
School of Public Health (PM), University of Minnesota, St. Paul

Correspondence: Corresponding author: Dwenda Gjerdingen, MD, MS, 580 Rice St, St. Paul, MN 55103 (E-mail: dgjerdin{at}umphysicians.umn.edu)

Purpose: The purpose of this study was to pilot a stepped collaborative care intervention for women with postpartum depression and evaluate health differences between self-diagnosed depressed and nondepressed women.

Methods: Five hundred six mothers of infants from 7 clinics completed surveys at 0 to 1, 2, 4, 6, and 9 months postpartum and a Structured Clinical Interview for DSM-IV (SCID). SCID-positive depressed women were randomized to stepped collaborative care or usual care. Nine-month treatment, health, and work outcomes were evaluated for stepped care women (n = 19) versus control depressed women (n = 20), and self-diagnosed depressed women (n = 122) versus nondepressed women (n = 344).

Results: Forty-five women had SCID-positive depression whereas 122 had self-diagnosed depression. For SCID-positive depressed women, the stepped care intervention increased mothers’ awareness of their depression diagnosis (100% vs 61%; P = .008) and their receipt of treatment (94% vs 56%; P = .019). Self-diagnosed depressed women (vs nondepressed women) had more depressive symptoms and acute care visits, worse general and mental health, and greater impact of health problems on regular activities.

Conclusions: The stepped care intervention improved women's knowledge of their postpartum depression diagnosis and their receipt of treatment. However, our formal diagnostic procedures missed many women whose depressed mood interfered with their health and function.

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				M. A. Bowman and A. V. Neale On Postpartum Depression, Hormonal Problems, and Practice Management for Medical Home Implementation J Am Board Fam Med, September 1, 2009; 22(5): 465 - 467. [Full Text] [PDF]

				A. Anderson Guest Family Physician Commentaries J Am Board Fam Med, September 1, 2009; 22(5): 471 - 472. [Full Text] [PDF]