New Jersey’s Efforts To Improve Postpartum Depression Care Did Not Change Treatment Patterns For Women On Medicaid

Kozhimannil, Katy B.; Adams, Alyce S.; Soumerai, Stephen B.; Busch, Alisa B.; Huskamp, Haiden A.

doi:10.1377/hlthaff.2009.1075

Cited by 67 publications

(62 citation statements)

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“…Although such discussion may be of value, its impact on outcomes is unknown, and to date, studies of referral after an initial or repeated screenings have found limited uptake of mental health services by the women referred from pediatric or obstetrical practices. 5,[32][33][34][35] It is therefore necessary to do studies of screening and repeated screening that actually include outcomes to determine whether assessments of risks or benefits can support evidence-based recommendations for rescreening.The factors associated with new elevation of PHQ-9 scores after a baseline screening score of less than 10 are similar to those associated with elevated scores in the more immediate postpartum period: history of depression, limited education, not being married, and anxiety. 3,4,11,12,20 We were unable to assess obesity, history of interpersonal violence, or social support, which have also been associated with PPD in some populations.…”

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confidence: 99%

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Repeated Depression Screening During the First Postpartum Year

Yawn

Bertram

Kurland

et al. 2015

The Annals of Family Medicine

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PURPOSE Postpartum depression (PPD) screening at 4 to 12 weeks' postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear. METHODSWe report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks' postpartum) and again at 6 and at 12 months' postpartum. The main outcomes of this substudy were the 6-and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation.RESULTS At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6-and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline. CONCLUSIONSRepeated PPD screening at 6 and 12 months' postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes. Ann Fam Med 2015;13:228-234. doi: 10.1370/afm.1777. INTRODUCTIONM aternal postpartum depression (PPD) is common, costly, and associated with adverse outcomes for mothers, infants, and families.1,2 There is limited outcomes-based evidence to support universal or routine PPD screening in the early postpartum period. [2][3][4][5][6] Neither the United States Preventive Services Task Force nor the American College of Obstetrics and Gynecology has made recommendations regarding routine PPD screening. 7,8 The American Academy of Pediatrics, however, recommends universal screening in the early postpartum period and screening for parental depression at each well-child visit.9,10 The basis for those recommendations appears to be evidence that PPD is currently underrecognized, 10,11 that screening increases recognition, 10,12 and that pediatricians can discuss and refer women at risk for depression. 10,13The need to evaluate rescreening is based in part on the natural history of PPD as reported in a meta-analysis by Gaynes et al of 28 studies that included about 15,000 women.1 The prevalence of PPD diagnosis based on assessment by clinical interviews was 3.8% at 4 weeks, increasing to 4.7% at 12 weeks, and 5.6% at 26 weeks. Rates then fell to 1.0% at 32 weeks and 3.9% at 52 weeks. The increasing prevalence of PPD up to 6 months' postpartum sugges...

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Repeated Depression Screening During the First Postpartum Year

Yawn

Bertram

Kurland

et al. 2015

The Annals of Family Medicine

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“…For example, studies that have evaluated universal screening in these settings among women enrolled in state Healthy Start and Medicaid programs, have found no observed changes in treatment usage [9,10]. In these studies, women who screened positive during integrated screening received referrals to other providers, presenting another barrier to diagnosis and treatment.…”

Section: Improving Clinician Skills and Coordination Of Carementioning

confidence: 99%

Barriers in the diagnosis and treatment of depression in women in the USA: where are we now?

Ko¹,

Farr²,

Dietz³

2013

Neuropsychiatry

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An estimated 14.8 million Americans aged 18 years and older, or approximately 6.7% of the adult US population, meet the criteria for major depressive disorder in any given year [1]. Women are almost twice as likely as men to report lifetime history of a major depressive episode, with their first episode occurring in adolescence through to mid-life [2]. An estimated 8-16% of US women aged 18-44 years are affected by depression [2,3]. Existing research has found depression to be associated with many adverse conditions throughout life, including concurrent psychiatric and substance use disorders, chronic conditions such as diabetes, decreased fertility, poor pregnancy outcomes such as preterm delivery or low birthweight infants, and impaired maternal functioning and bonding.Compared with men, women are more likely to visit their physician [101] and frequently interact with the healthcare system, especially during reproductive years [102]. However, only half of women with depression receive a clinical diagnosis [3], which is often the first step to treatment. Studies have shown that women who are younger, non-Hispanic white and uninsured are less likely to receive clinical diagnoses [3,4]. These groups are also less likely to seek treatment [5] and to receive appropriate treatment when care is sought [6]. Barriers to care have been well documented in the literature and include financial constraints such as healthcare coverage, fragmented care and stigma [3,7]. Given these constraints, addressing barriers in diagnosis and treatment of women with depression must be a multifaceted approach. Addressing financial constraints including lack of healthcare coverageLack of health insurance is often a barrier to receiving care for depression. The Affordable Care Act (ACA) of 2010 increases access to health insurance coverage through a number of provisions, including employer coverage requirements, small business tax credits, refundable premium subsidies and health insurance exchanges [103]. Additionally, the ACA's expansion of Medicaid could provide coverage for up to an estimated 10 million currently

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“…10 Additionally, research examining the impact of New Jersey's legislated efforts to screen women potentially experiencing postpartum depression (PPD) indicates that in spite of widespread provider screening, lower-income women in particular did not experience any significant change in receipt of mental health services after that policy's implementation. 11 A consistent issue raised across studies is the gap between identification and treatment; specifically, the availability of adequate mental health services and successful linkage from health provider screening to these services, particularly for low-income women.…”

Section: Policy Initiatives Regarding Perinatal Depressionmentioning

confidence: 99%

“…2,12,13 It is the formal medical provider sector, however, that is the focus of the present study because many women seek formal healthcare during pregnancy and the postpartum, even if they did not have health providers. 11 Best practices for healthcare providers are readily available, including written guidelines for physicians about screening and referral of pregnant and postpartum women, complete with algorithms to help guide appropriate clinical decision making. [14][15][16] In spite of these successes, moving from increased provider knowledge about screening and treatment/referral to realworld translation and implementation of screening and intervention by these health professionals has been a larger challenge.…”

Section: Journal Of Women's Healthmentioning

confidence: 99%

Perinatal Depression Screening and Intervention: Enhancing Health Provider Involvement

Price

Corder-Mabe

Austin

2012

Journal of Women's Health

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Objective: The authors of this study collaborated in the analysis of public health survey data in order to inform future statewide interventions that could systematically enhance depression screening and mental health service use for women of reproductive age. The primary objective of the study was to empirically inform and test the program theory components of a motivational interviewing intervention that we anticipate will guide statewide practice and policy priorities. Methods: Data were examined from a survey of healthcare practitioners statewide (n = 1498) regarding their practices with and perceptions of perinatal depression care for women. Confirmatory factor analysis (CFA) was used to measure two latent constructs: health provider confidence in the ability to diagnose and treat and the importance placed on screening and treatment. Structural equation modeling (SEM) was used to test a program theory supporting motivational interviewing using a model implied relationship between confidence and importance on screening and treatment/referral practices. Results: The data fit the model; the model provisionally supports motivational interviewing as an intervention influencing provider attitudes and practices surrounding perinatal depression screening and treatment/referral. Conclusions: Ultimately, study findings support statewide public health efforts to expand the role of health providers in recognizing and responding to perinatal depression and suggest that motivational interviewing techniques that augment importance and confidence may lead to enhanced screening and referral/treatment outcomes for pregnant and postpartum women.

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New Jersey’s Efforts To Improve Postpartum Depression Care Did Not Change Treatment Patterns For Women On Medicaid

Cited by 67 publications

References 42 publications

Repeated Depression Screening During the First Postpartum Year

Repeated Depression Screening During the First Postpartum Year

Barriers in the diagnosis and treatment of depression in women in the USA: where are we now?

Perinatal Depression Screening and Intervention: Enhancing Health Provider Involvement

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