Background
Both antenatal and postpartum depression have adverse, lasting effects on maternal and child well-being. Socio-economically disadvantaged women are at increased risk for perinatal depression and have experienced difficulty accessing evidence-based depression care. The authors evaluated whether “MOMCare,”a culturally relevant, collaborative care intervention,providing a choice of brief interpersonal psychotherapy and/or antidepressants,is associated with improved quality of care and depressive outcomes compared to public health Maternity Support Services(MSS-Plus).
Methods
A randomized multi-site controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System. From January 2010-July 2012, pregnant women were recruited who met criteria for probable major depression and/or dysthymia, English-speaking,had telephone access, and ≥18-years-old. The primary outcome was depression severity at 3-,6-,12-,18-month postbaseline assessments; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care.
Results
All participants were on Medicaid and 27-years-old on average; 58% were non-white; 71% were unmarried; and 65% had probable PTSD. From before birth to 18-months-postbaseline, MOMC are (n=83) compared to MSS-Plus participants (n=85) attained significantly higher rates of depression remission (Wald'sχ2=3.67,df=1,p=.05), lower levels of depression severity (Wald's χ2=6.09, df=1,p=.01) and PTSD severity (Wald'sχ2=4.61,df=1,p=.04), and had a greater likelihood of receiving ≥4 mental health visits (Wald'sχ2=58.23,df=1,p<.0001) and of adhering to anti-depressants in the prior month (Wald'sχ2=10.00,df =1,p<.01).
Conclusion
Compared to MSS-Plus, MOMCare showed significant improvement in quality of care, depression severity and remission rates from before birth to 18-months-postbaseline for socioeconomically disadvantaged women. Findings suggest that evidence-based perinatal depression care can be integrated into the services of a county public health system in the US.