Best Practices: An Emerging Best Practice Model for Perinatal Depression Care

Perinatal depression is a significant health problem, especially among inner-city women.The authors explored the feasibility of an innovative model that integrated depression screening and treatment within an agency for maternal-child health.The team conducted depression screening with the Edinburgh Postnatal Depression Scale; they confirmed the primary diagnosis with the PRIME-MD instrument for 29 women with positive screens.Most participants had moderate or severe major depressive disorder.Women contended with multiple treatment barriers.Colocated depression care was highly acceptable and enabled evidence-based care delivery for at-risk mothers.Perinatal depression is a major public health problem.A striking 14.5% of women experience a new episode of depression during pregnancy or the first three months after delivery (1).Higher rates occur among inner-city women in low-income households (2).Perinatal depression-that is, major depressive disorder with onset during pregnancy or the first postpartum months-is characterized by low recognition and treatment rates.It is impossible to diagnose depression without a clinical examination.In fact, the theme of the Perinatal Depression Awareness Campaign (www.perinatalweb.org) is "You can't tell without looking."Low rates of recognizing and treating perinatal depression may be attributed to the failure to screen new mothers for depression.Maternal mental health care remains a major unmet need.The annual report of Healthy Start, Inc., of Pittsburgh reported that 40% of mothers whose children were in the program were considered to be at high risk for major depression, but only 16% of women who were referred for treatment attended the initial appointment.The current fragmented system of health care makes it difficult to identify the appropriate locus of care for an affected patient.Therefore, interventions that combine case identification, activation of the patient to seek care, physician education, and system-level efforts to support coordination of care are critical to improve outcomes of depressed mothers.Collaborative care, which involves a multispecialty team based in the primary care setting, is one strategy to improve depression management and increase the likelihood of recovery.This model of one-stop intervention appeals to perinatal patients because it is affordable andThe other authors report no competing interests.