Nonpsychotic major depression (MOD) occurs in 10-20 percent of women within 6 months of delivery with higher rates seen following preterm birth. Patient factors which reduce participation in care for MOD are major barriers to the delivery of effective depression treatments. Adults with low literacy have higher risk of depressive symptomatology and less utilization of a variety of health care services 20-37 percent of women in populations most at risk for maternal health disparities have low literacy (< 6th grade). The health literacy construct, the capacity to access information needed for health decisions, has been proposed as a mediator of the association between low literacy and low health care service use. Assessing the role of low literacy in the utilization of care for MOD identified postpartum may allow interventions that would reduce barriers to treatment for this vulnerable population. This application outlines a mixed methods study (R03) in which qualitative methods will be added to an ongoing randomized controlled trial to treat risk factors for repeat preterm birth (n=1420). Participants who are diagnosed with DSM-IV MOD following an early preterm birth (<34 weeks EGA) will be offered a choice of free treatments (psychotherapy, antidepressant medication, or a combination of the two). The primary aims of this investigation of women with depression and low literacy (< 6th grade, n=117) are to: 1) Identify factors associated with accepting versus declining referral for depression care among women with high depressive symptomatology (CES-D 22); 2) Identify factors associated with accepting versus declining any of the active treatments for depression offered among women with DSM-IV MOD; and 3) ldentify factors associated with depression treatment continuation versus discontinuation among women with DSM-IV MOD. The proposed study will take advantage of extensive quantitative data collected in the parent study which will be linked to qualitative analyses of transcripts from semi-structured interviews (n=60) and clinical interviews (n=40) The qualitative methods will greatly enhance the quantitative assessments, provide an opportunity to clarify inconsistencies in results, and an opportunity to uncover novel factors linking health literacy and depression treatment utilization. This study represents a unique and cost effective opportunity to study patient factors which are obstacles to depression treatment in women with low literacy and inform future interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Small Research Grants (R03)
Project #
1R03MH074750-01
Application #
6961049
Study Section
Special Emphasis Panel (ZRG1-RPHB-J (50))
Program Officer
Moten, Carmen P
Project Start
2005-09-15
Project End
2007-06-30
Budget Start
2005-09-15
Budget End
2006-06-30
Support Year
1
Fiscal Year
2005
Total Cost
$74,012
Indirect Cost
Name
University of Pennsylvania
Department
Family Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Webb, David A; Mathew, Leny; Culhane, Jennifer F (2014) Lessons learned from the Philadelphia Collaborative Preterm Prevention Project: the prevalence of risk factors and program participation rates among women in the intervention group. BMC Pregnancy Childbirth 14:368
Webb, David A; Coyne, James C; Goldenberg, Robert L et al. (2010) Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: the Philadelphia Collaborative Preterm Prevention Project. BMC Med Res Methodol 10:88
Bennett, Ian M; Marcus, Steven C; Palmer, Steven C et al. (2010) Pregnancy-related discontinuation of antidepressants and depression care visits among Medicaid recipients. Psychiatr Serv 61:386-91
Bennett, Ian M; Culhane, Jennifer F; Webb, David A et al. (2010) Perceived discrimination and depressive symptoms, smoking, and recent alcohol use in pregnancy. Birth 37:90-7
Mora, Pablo A; Bennett, Ian M; Elo, Irma T et al. (2009) Distinct trajectories of perinatal depressive symptomatology: evidence from growth mixture modeling. Am J Epidemiol 169:24-32
Bennett, Ian M; Coco, Andrew; Anderson, Janice et al. (2009) Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network. J Am Board Fam Med 22:380-6
Bennett, Ian M; Palmer, Steven; Marcus, Steven et al. (2009) ""One end has nothing to do with the other:"" patient attitudes regarding help seeking intention for depression in gynecologic and obstetric settings. Arch Womens Ment Health 12:301-8
Webb, David A; Bloch, Joan R; Coyne, James C et al. (2008) Postpartum physical symptoms in new mothers: their relationship to functional limitations and emotional well-being. Birth 35:179-87
Bennett, Ian M; Coco, Andrew; Coyne, James C et al. (2008) Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study. J Am Board Fam Med 21:317-25
Bennett, Ian M; Culhane, Jennifer F; McCollum, Kelly F et al. (2007) Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency. Am J Orthopsychiatry 77:243-8

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