(provided by PI): Postpartum depression (PPD), seen in approximately 10-20% of women who give birth, is the most common serious postpartum health disorder, with documented effects on mothers' physical and mental health, relationships, work performance, and infant development. Despite its seriousness, PPD remains undiagnosed and untreated for most women. This pilot study will test the feasibility of implementing an innovative intervention in which mothers are routinely screened for depression during well-child visits (an on-going point of contact between mothers and providers during the postpartum); and, if diagnosed with PPD, treated according to a collaborative Stepped Care treatment approach, consisting of primary care physician visits, regular case manager telephone follow-up, and consultation with/referral to a mental health specialist as warranted. The Stepped Care approach has empirical support for use with primary care populations, but has not yet been tested in a postpartum sample, for which risks for depression and barriers to treatment are greater. There are four aims: 1) test the feasibility (e.g., response rate, treatment compliance) of implementing a depression screening/Stepped Care treatment program in the context of well-child visits and compare feasibility between pediatric and family practice clinics; 2) determine physician and patient satisfaction with the intervention (overall, and its separate components); 3) assess the intervention's impact on mothers' and infants' health outcomes and mothers' work productivity; 4) investigate partners' willingness to participate in a large follow-up trial and identify factors that might encourage them to participate. In the pilot, 400 mothers of newborn infants receiving care at 7 pediatric and family practice clinics will be screened for depression at well-child visits from 0-6 months postpartum, using the PHQ-9 and 2-Question depression screens. Diagnoses will be verified by SCID telephone interviews. Mothers with PPD will be randomized to a control (usual care) or experimental (Stepped Care treatment) group. Effectiveness outcomes include mental health (PHQ-9 scores, SF-36 mental health scale), days ill, SF-36 General Health, illness visits, and Work Productivity and Activity Impairment. This pilot prepares the way for a more definitive follow-up trial that will test a refined stepped care intervention in a larger, more diverse, multi-site sample of postpartum depressed mothers and their partners. ? ?
