Stepped care treatment of postpartum depression: a primary care-based management model.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
Stepped care, a form of collaborative depression treatment, is proposed as a practical, cost-effective method for improving PPD diagnosis and clinical outcomes.
Gjerdingen
Dwenda
D
Department of Family Medicine & Community Health, University of Minnesota, St. Paul, MN 55103, USA. dgjerdin@umphysicians.umn.edu
Katon
Wayne
W
Rich
Deborah E
DE
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000458:organization & administration; D019052:Depression, Postpartum / Q000191:economics / Q000628:therapy*; D005194:Family Practice / Q000191:economics*; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011613:Psychotherapy / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D014481:United States; D016387:Women's Health; D014932:Women's Health Services / Q000191:economics / Q000458:organization & administration*