Stepped Care Treatment of Postpartum Depression: A Primary Care-Based Management Model
Received 19 February 2007; accepted 25 September 2007.
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.
aDepartment of Family Medicine & Community Health, University of Minnesota, St. Paul, Minnesota
bDepartment of Psychiatry, University of Washington, Seattle, Washington
cBirth and Family Education and Support Department, Fairview Health Systems, Minneapolis, Minnesota
Correspondence to: Dwenda Gjerdingen, MD, Department of Family Medicine & Community Health, University of Minnesota, 580 Rice St., St. Paul, MN 55103; Phone: 651-227-6551; Fax: 651-227-1804.
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.
2 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.
ABSTRACT