Improving depression treatment for women: integrating a collaborative care depression intervention into OB-GYN care.
BACKGROUND
Women have higher rates of depression and often experience depression symptoms during critical reproductive periods, including adolescence, pregnancy, postpartum, and menopause. Collaborative care intervention models for mood disorders in patients receiving care in an OB-GYN clinic setting have not been evaluated. Study design and methodology for a randomized controlled trial of collaborative care depression management versus usual care in OB-GYN clinics and the details of the adapted collaborative care intervention and model implementation are described in this paper.


METHODS
Women over age 18 years with clinically significant symptoms of depression, as measured by a Patient Health Questionnaire-9 (PHQ-9) score ≥10 and a clinical diagnosis of major depression or dysthymia, were randomized to the study intervention or to usual care and were followed for 18 months. The primary outcome assessed was change over time in the SCL-20 depression scale between baseline and 12 months.


RESULTS
Two hundred five women were randomized: 57% white, 20% African American, 9% Asian or Pacific Islander, 7% Hispanic, and 6% Native American. Mean age was 39 years. 4.6% were pregnant and 7.5% were within 12 months postpartum. The majority were single (52%), and 95% had at least the equivalent of a high school diploma. Almost all patients met DSM IV criteria for major depression (99%) and approximately 33% met criteria for dysthymia.


CONCLUSIONS
An OB-GYN collaborative care team, including a social worker, a psychiatrist, and an OB-GYN physician, who met weekly and used an electronic tracking system for patients was the essential element of the proposed depression care treatment model described here. Further study of models that improve quality of depression care that are adapted to the unique OB-GYN setting is needed.
Department of Obstetrics and Gynecology, University of Washington Medical School, Seattle, WA, USA. Electronic address: alarocco@uw.edu.
Anna
A
LaRocco-Cockburn
Susan D
SD
Reed
Jennifer
J
Melville
Carmen
C
Croicu
Joan E
JE
Russo
Michal
M
Inspektor
Eddie
E
Edmondson
Wayne
W
Katon
D000928:Antidepressive Agents / Q000627:therapeutic use; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006176:Gynecology / Q000379:methods*; D006801:Humans; D009774:Obstetrics / Q000379:methods*; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology / Q000628:therapy; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods
D000928:Antidepressive Agents
Collaborative care model; Depression in women; Obstetrics and gynecology; Postpartum; Pregnancy; Reproductive stages