Depression in perinatal women confers substantial medical, psychiatric, social and developmental risk to children (NAS, 2009) and remains a critical and under-addressed public health problem. Population specific differences, or disparities, in the presence (prevalence) and persistence of perinatal depression as well as in access to care are poorly understood. The Agency for Healthcare Research and Quality Evidence Report (2005) and the National Academy of Sciences / Institute of Medicine Report on Depression in Parents (2009) both outline a clear gap in understanding of depression around the time of childbearing in minority women, rural and low SES women. This proposal is a Competitive Revision Application for Targeted Research on Mental Health Disparities NOT-MH-10-021. As required by the RFA for this proposal, it is submitted as a revision of a current parent NIMH grant entitled, """"""""Placebo Controlled Trial of Sertraline and IPT for Postpartum Depression (1 R01 MH074636-01A2;Stuart PI). The purpose of the proposal, as described by the NIMH RFA, is """"""""to conduct secondary analyses to target research questions addressing mental health disparities."""""""" The Revised Application aims overall to combine and analyze important sub-group differences to provide novel information on disparities in perinatal depression and treatment use. The parent grant will contribute data from over 5500 perinatal women who have been screened in the project to date. Additional data will be obtained from the Women's Mood Disorder (WMD) Task group, a part of the National Network of Depression Centers that was established 2009 in order to synergistically advance the field of women's depression by capitalizing upon the strengths and expertise of a collaborative network. The Revised Application will aggregate and analyze 12 individual WMD member databases in order to address key disparities-related questions related to depression in women around the time of childbearing and to provide information on population differences in course and treatment use (engagement and adequacy) from pregnancy through postpartum. The proposed aims cannot be addressed by any of the individual databases due to inadequate statistical power. All groups have collected similar depression and treatment use measurements from multiple sites and treatment settings. The pooled sample will include >30,000 perinatal women, and will include large numbers of women from diverse racial minority (n=5117), SES, and geographical groups for key comparative analyses. This data will be used to develop a clinical tool to overcome disparities in treatment which will allow clinicians to tailor interventions to specific settings and individual women. In addition, this project will establish collaborative capacity and infrastructure of the WMD to advance multi-site, interdisciplinary collaborative research on women's depression with an emphasis on understanding and addressing health disparities.
The proposed study will provide critical information about population specific differences, or disparities, in the presence (prevalence) and persistence of perinatal depression as well as access to treatment. Data from 12 studies will be aggregated and will include more than 30,000 perinatal women, including 5117 minority women. This data will be used to overcome disparities in treatment and assist underserved women to better receive mental health care.
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