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Stepped Care Treatment of Postpartum Depression: Impact on Treatment, Health, and Work Outcomes
Journal of the American Board of Family Medicine, 09/08/09

Gjerdingen D et al. – The stepped care intervention improved women's knowledge of their postpartum depression diagnosis and their receipt of treatment. However, our formal diagnostic procedures missed many women whose depressed mood interfered with their health and function.

• 506 mothers of infants from 7 clinics completed surveys at 0 to 1, 2, 4, 6, and 9 months postpartum and a Structured Clinical Interview for DSM–IV (SCID).
• SCID–positive depressed women were randomized to stepped collaborative care or usual care.
• Nine–month treatment, health, and work outcomes were evaluated for stepped care women versus control depressed women, and self–diagnosed depressed women versus nondepressed women.

• 45 women had SCID–positive depression whereas 122 had self–diagnosed depression.
• For SCID–positive depressed women, the stepped care intervention increased mothers’ awareness of their depression diagnosis and their receipt of treatment.
• Self–diagnosed depressed women (vs nondepressed women) had more depressive symptoms and acute care visits, worse general and mental health, and greater impact of health problems on regular activities.

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