Improving the Care of Pregnant Women with Depression

Submitted by:Ian Bennett MD PhD, University of Pennsylvania

Depression is a common disorder among women in pregnancy and in the year following childbirth. Perinatal depression includes a range of emotional disorders - from something fairly mild and temporary to major depression that may require psychotherapy and medications. Perinatal depression is linked to preterm birth and low birth weight when occurring in pregnancy and it’s linked to emotional disorders in children when it occurs among parenting mothers. While offices that provide prenatal and postpartum care are more aware of the seriousness of depression in pregnancy, very few have implemented evidence-based approaches to ensure that women can get help with this disorder.

The problem is particularly great among low-income, and race and ethnic minority women. It’s been found that the rate of emotional distress (a risk factor for depression) can be as high as 50 percent, but the likelihood of being detected and treated for depression is particularly low.

The Care Managers for Perinatal Depression (CMPD) study, funded by the Robert Wood Johnson Foundation, is an effort to implement evidence-based practices to increase the quality of perinatal depression care in Southeast and South Central Pennsylvania. The Thomas Heart Family Practice Center of York Hospital is one of four sites in the region that is participating in this three-year study. Aligning Forces for Quality – South Central PA is collaborating with CMPD to disseminate information about the study (and eventually its findings) to medical sites in the area that provide prenatal or postpartum care.

The other study sites in the area include the Downtown Family Medicine of Lancaster General Health and Southeast Lancaster Health Services. A Federally Qualified Health Center (FQHC) in Philadelphia, Spectrum Health Services, is the fourth participating site. The study is led collaboratively by faculty from Lancaster General Health and the University of Pennsylvania.  Starting with the first prenatal visit, the CMPD sites make use of efficient screening protocols developed and tested in primary care prenatal settings, and the collaborative care model for depression to increase the identification, diagnosis, and appropriate treatment of women with mood disorders. The collaborative care model focuses on using a multi-disciplinary team approach to care, with the use of a care manager, which has been shown in more than forty, high quality randomized trials to improve the treatment of depression. Despite the extensive evidence supporting this approach, very few health sites have implemented the model.  In addition, the CMPD project emphasizes treatment within the patients’ established medical home to reduce the well-documented loss of patients related to referral to specialty mental health sites.

Please feel free to contact the researchers involved at Lancaster General Health and the University of Pennsylvania with any questions about this work and how it might apply to your own medical practices. Dr. Steven Ratcliffe of Lancaster General and Dr. Ian Bennett of the University of Pennsylvania are Co-Primary Investigators, and would be pleased to hear from anyone with interest in the project.

Please contact Steven Ratcliffe MD MPH (sdratcli@lghealth.org), Ian Bennett MD PhD (ian.bennett@uphs.upenn.edu) or Angela Gambler, the study coordinator, (agambler2@lghealth.org) for further information.
 
 

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