T- BOOM Teens--Building Options and Opportunities for Moms
Condition: Postpartum Major Depression
MeSH terms: Depression; Depressive Disorder, Major
Study type: Interventional

Summary: 
      Postpartum depression (PPD) is depression that occurs shortly after the mother delivers her
      baby. Mothers with postpartum depression may feel sad mood, low motivation or stress; some
      may have problems caring for their new baby. Successful depression treatment involves early
      screening and detection of postpartum depression and early access to treatment services.

      The purpose of this study is to evaluate the effectiveness of a telephone-based depression
      screening and care management program for postpartum women. We will evaluate the: 1) how
      often (frequency) young mothers develop symptoms of depression 4 to 6 weeks after birth, 2)
      how quickly (timeliness) young mother receive treatment and how effective (adequacy) are the
      treatments for the symptoms of postpartum depression, 3) the effects of depression care
      support on young mothers' symptoms and their ability to function at 3, 6 and 12 months after
      entering the study, 4) visits to the pediatrician or nurse practitioner (preventive health
      services) during their baby's first year of life, and 5) cost and cost savings associated
      with depression care management.
    

Detailed description: 
      Depression during the perinatal period is a major public health concern. Postpartum
      depression (PPD) causes personal and family suffering at a time when adaptation to parenthood
      is critical. Successful interventions for treating depression in medical settings have been
      framed by a chronic disease management model. The key ingredient to success is a dedicated
      care manager who provides education and support to patients, actively coordinates care, and
      thereby improves treatment outcomes for patients. Compared to interventions in medical office
      settings, telephone care management positioned at the level of the health plan offers a
      systematic and efficient mechanism for ongoing treatment support of women with PPD,
      particularly in a geographically dispersed population.

      We propose to conduct a comprehensive project to improve treatment outcomes for depressed
      postpartum women through adaptation of the depression care management model used in primary
      care settings. The major components are: 1) depression screening in a population of
      postpartum adolescents, 2) depression education for all who screen positive, 3) a diagnostic
      interview to evaluate for depressive disorders in mothers who score above and below a defined
      threshold on the screening instrument, 4) telephone-based care management intervention, and
      5) longitudinal evaluation across the first year post-birth for depression and maternal and
      child public health outcomes. Focus groups will precede the major study components. A focus
      group of adolescent mothers will inform the investigators about the barriers to depression
      care management that encompass resource needs, acceptability of interventions to cope with
      stress or depression, and access to care. A separate focus group of community professionals
      of representatives from agencies or groups that provide community supports and health
      services will be used to explore the perceptions of barriers to care for new adolescent
      mothers. All participants in this project will be eligible for mental health services through
      their health plans that serve Medicaid and commercial members.

      We plan to identify 125 child or adolescent new mothers with PPD. The child or adolescent new
      mothers will be assigned to depression care management. They will be supported in making
      choices about depression treatment (after receiving education about options), encouraged to
      access their preferred treatment (through the direct discussion of barriers and solutions),
      counseled to comply with treatment recommendations, and assisted to problem-solve if failure
      to respond occurs. All participants will have systematic evaluations at 3, 6, and 12 months
      post-birth. Outcomes include not only maternal depressive symptom levels but also functional
      and public health outcomes for mothers, families, and infants. We have developed a
      multi-disciplinary team with expertise in clinical research with depressed and minority women
      and health services to address these needs.
    

Intervention name(s): repeated mood measures and phone depression care management
Intervention type(s): Other
Intervention description(s): The adolescent mothers will be assigned a depression care management who will support the mother in making choices about depression treatment, educate about treatment options, discuss barriers and solutions, counsel to comply with treatment recommendations, and assisted to problem-solve if failure to respond occurs.
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: postpartum major depression; adolescent mothers; telephone depression care management; barriers to depression care