Collaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment Response.
The study examined the effectiveness of a perinatal collaborative care intervention in moderating the effects of adverse neonatal birth events on risks of postpartum depressive symptoms and impaired functioning among women of lower socioeconomic status with antenatal depression.



A randomized controlled trial with blinded outcome assessments was conducted in ten public health centers, comparing MOMCare (choice of brief interpersonal psychotherapy, pharmacotherapy, or both) with intensive maternity support services (MSS-Plus). Participants had probable diagnoses of major depressive disorder or dysthymia during pregnancy. Generalized estimating equations estimated differences in depression and functioning measures between groups with and without adverse birth events within the treatment arms. A total of 160 women, 43% of whom experienced at least one adverse birth event, were included in the analyses.



For women who received MOMCare, postpartum depression scores (measured with the Symptom Checklist-20) did not differ by whether or not they experienced an adverse birth event (mean±SD scores of .86±.51 for mothers with an adverse birth event and .83±.56 for mothers with no event; p=.78). For women who received MSS-Plus, having an adverse birth event was associated with persisting depression in the postpartum period (mean scores of 1.20±.0.61 for mothers with an adverse birth event and .93±.52 for mothers without adverse birth event; p=.04). Similar results were seen for depression response rates and functioning.



MOMCare mitigated the risk of postpartum depressive symptoms and impaired functioning among women of low socioeconomic status who had antenatal depression and who experienced adverse birth events.
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Amritha
A
Bhat
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Nancy K
NK
Grote
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Joan
J
Russo
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Mary Jane
MJ
Lohr
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Hyunzee
H
Jung
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Caroline E
CE
Rouse
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Elaine C
EC
Howell
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Jennifer L
JL
Melville
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Kathy
K
Carson
Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: amritha@uw.edu ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle.
Wayne
W
Katon
D000293:Adolescent; D000328:Adult; D019052:Depression, Postpartum / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D000070516:Intersectoral Collaboration; D008427:Maternal Health Services / Q000458:organization & administration; D008484:Medicaid / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D011256:Pregnancy Outcome / Q000453:epidemiology; D011614:Psychotherapy, Brief / Q000379:methods; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations; D055815:Young Adult
Adverse birth event; Collaborative care; Perinatal depression