title: Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: the design of the MOMCare study.
abstract: BACKGROUND
  Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS).
  
  
  METHODS
  Pregnant, public health patients, >18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum).
  
  
  RESULTS
  168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making <$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy.
  
  
  CONCLUSIONS
  A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study.
authors.affiliation: School of Social Work, University of Washington, Seattle, WA, USA. Electronic address: ngrote@u.washington.edu.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Grote
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.affiliation: School of Social Work, University of Washington, Seattle, WA, USA.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Lohr
authors.affiliation: Public Health Seattle and King County (PHSKC), Seattle, WA, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Carson
authors.affiliation: School of Social Work, University of Washington, Seattle, WA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Curran
authors.affiliation: School of Social Work, University of Washington, Seattle, WA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Galvin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.affiliation: School of Social Work, University of Washington, Seattle, WA, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Gregory
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D054521:Cultural Competency; D019052:Depression, Postpartum / Q000523:psychology / Q000628:therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008484:Medicaid; D008605:Mental Health Services / Q000458:organization & administration*; D011203:Poverty; D011295:Prenatal Care / Q000458:organization & administration*; D012107:Research Design; D012720:Severity of Illness Index; D012947:Social Work / Q000458:organization & administration*; D014481:United States; D035862:Vulnerable Populations / Q000523:psychology
keywords: Collaborative care model; Obstetrics and gynecology; Perinatal depression; Postpartum; Pregnancy; Public health