Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID): A Master’s Thesis

Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care

Adapting and Testing the Feasibility of a Prenatal Intervention for Low-Income Parents [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files. Learn about a new pilot study that aims to improve the mental health and co-parenting relationships of underserved, low-income parents and their partners. Adapting and Testing the Feasibility of a Prenatal Intervention for Low-Income Parents will adapt and test the feasibility of a group-based intervention called Choices in Childbirth & Co-Parenting (3CP) aimed at reducing depression and stress among low-income new mothers and their partners early in pregnancy. Funded by the UMASS Medical School Center for Clinical and Translational Science (UMCCTS) this pilot project is a collaborative effort among UMass Amherst, UMass Medical School, Square One, and the Children’s Trust

Addressing Perinatal Depression in the Outpatient Obstetric Setting

Presentation will discuss: (1) barriers that OB/Gyn providers and support staff encounter in recognizing depression and engaging perinatal women in treatment, (2) strategies to overcome barriers to treatment and (3) the development of interventions aimed at improving treatment entry and follow-up

Why pregnant women with depression often slip through the cracks

One in seven women experience depression during pregnancy and after they give birth. This article explains how a model the authors created in Massachusetts to ensure that women with depression get the help they need is being implemented in other states

PRogram In Support of Moms (PRISM) Research Study [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files below. An ongoing pilot study of PRISM (PRogram In Support of Moms) suggests that while both MCPAP (Massachusetts Child Psychiatry Access Project) for Moms and PRISM improve maternal perinatal depression symptoms, there is a greater decrease in depression severity with the additional intervention components included in PRISM. Over the next 5 years, investigators will run a randomized control trial that compares a set of 6 Massachusetts practices using MCPAP for Moms to a set of 6 practices using MCPAP for Moms plus PRISM

Listening to Mothers: What\u27s Helpful for Mothers Experiencing Perinatal Depression [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files below. Understanding the experiences of women who have experienced perinatal depression may help inform needed changes in how health care professionals and organizations screen, diagnose, and treat perinatal depression

5 Tips to Treating Women with Perinatal Depression

Approximately 1 in 7 women experience perinatal depression, a depressive episode that occurs during pregnancy or within the first year after delivery or adoption. This tip sheet has 5 ways health care providers can help women who are experiencing perinatal depression. This tip sheet is based off of Listening to Mothers: What\u27s Helpful for Mothers Experiencing Perinatal Depression

Overcoming Barriers to Addressing Perinatal Depression: Perspectives of Women [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files below. Despite the availability of effective evidence-based treatmentsand frequent contact with OB/Gyn providers, perinatal depression remains under-diagnosed and under-treated. Understanding the perceptions of women who have experienced perinatal depression may inform needed changes in screening, assessment, treatment, and prevention

Creating the Capacity to Screen Deaf Women for Perinatal Depression [poster]

There are approximately 1 million Deaf women in the U.S. who depend on American Sign Language (ASL) for communication. Although Deaf women become pregnant and enter motherhood at rates similar to hearing women, Deaf women attend fewer prenatal appointments, receive less information from their physicians, are less satisfied with physician concern and quality of communication, and are less satisfied with their prenatal care. These barriers persist after childbirth, leaving Deaf mothers with little professional support for struggles with postnatal healthcare, breastfeeding, and childcare. Combined with pre-existing mental health disparities observed among members of the Deaf community, such barriers leave Deaf women especially vulnerable to development or exacerbation of depression during the perinatal period (i.e., during pregnancy or within one year postpartum). Expert groups recommend depression screening as a standard of perinatal care - the first critical step to direct women to treatment. Yet, available screening tools are not accessible to Deaf women due to documented low levels of English literacy and health literacy. It is, therefore, critical to develop and validate tools to screen for depression among Deaf perinatal women so they may access the same standard of care as other perinatal women. To address these barriers, our team is conducting a one-year, community-engaged pilot study to develop and perform preliminary psychometric analyses on an ASL translation of the Edinburgh Postnatal Depression Scale (EPDS). During the poster session, we will outline our unique community-engaged research methods, as well as exhibit the first draft of the ASL EPDS

Overcoming Barriers to Perinatal Depression Treatment

Background Untreated perinatal depression is common and has deleterious effects on mother, fetus/child and family Despite effective evidence-based treatment for perinatal depression, most women do not get treatment Obstetricians have not traditionally identified and/or responded to the mental health needs of perinatal women Caring and committed providers are frustrated and confused5 and mothers do not feel seen, heard or understood by their providers Implementing supports for perinatal women within the traditional medical model poses many challenges to mental health and obstetric providers MotherWoman is a community-based grassroots organization dedicated to preventing and treating perinatal depression through an innovative organizational change approach, the Community-Based Perinatal Support Model (CPSM). This model includes: Peer-led support groups for perinatal women Organizational change interventions that include structured screening and referral, health care provider trainings and networks, and resource and referral guides Methods Participants Four focus groups with MotherWoman clients, 3 months – 3 years postpartum who self-identified as having experienced perinatal depression or emotional crisis Data collection Focus group probes targeted perceptions of the best practices to engage perinatal women in depression treatment and potential strategies for change Investigators met after each group to record observations and review verbatim notes Participants received gift cards for their participation Data analysis Transcripts were reviewed, segmented, and coded by investigators using an iterative, constant-comparative process to identify emerging themes and recurrent patterns Inter-rater reliability of more than 90% was achieved by two investigators comparing randomly selected coded pages from focus group notes Discussion Despite barriers, numerous facilitators to treatment were identified Supporting women’s mental health during the perinatal time period should ideally be done in both the medical setting and community Supporting the mental health of perinatal women is a fundamental challenge with multiple opportunities for intervention and education Strategies to address perinatal depression include: Offer training to OB/Gyn and mental health providers in the detection and screening of perinatal depression Prepare women for the postpartum period through psychoeducation and peer-support Create flexible treatment options that go beyond medication management and emphasize transition to motherhood Results will Contribute to understanding the barriers and facilitators perinatal women experience when trying to access depression treatment Provide preliminary guidelines for the development of strategies to engage perinatal women in depression treatment Inform the development of interventions that aim to integrate the treatment of perinatal depression into medical setting