Article Figures & Data
Figures
- Figure 1.
Flow diagram of participants’ progress through phases of the study. PPD, postpartum depression.
Tables
- Table 1.
Baseline Comparisons between Stepped Care and Control Subjects on Demographic and Health Characteristics
Characteristics Stepped Care (n = 19) Control (n = 20) P* Age (mean yrs [SD]) 27.2 (5.2) 28.0 (7.3) .717 ≤High school education (n [%]) 10 (52.6) 12 (60.0) .843 Non-white (n [%]) 11 (57.9) 13 (65.0) .748 Total family income <$40,000 (n [%]) 16 (84.2) 13 (65.0) .278 Receiving medical assistance (n [%]) 15 (83.3) 9 (52.9) .075 Married (n [%]) 5 (26.3) 8 (40.0) .501 Number of children (mean [SD]) 2.8 (1.4) 2.2 (1.1) .204 Patient Health Questionnaire-9 score (mean [SD])† 10.5 (8.5) 11.7 (7.2) .652 Mental health score (mean [SD])‡ 18.1 (6.3) 18.0 (5.8) .978 General health score (mean [SD])§ 2.9 (0.9) 3.2 (0.8) .253 Number of illness days (mean [SD]) Mother 1.9 (4.2) 2.5 (4.8) .728 Infant 0.7 (3.2) 0.4 (1.6) .639 Number of acute care visits (mean [SD]) Mother 0.3 (0.7) 0.6 (2.0) .631 Infant 0.1 (0.5) 0 (0) .331 * Determined by χ2 and ttests. Percentages are expressed as the percent of the given treatment group.
† Patient Health Questionnaire-9 score range = 0–27, with higher numbers representing more depressive symptoms.
‡ Mental Health score range = 5–30, with higher numbers representing better mental health.
§ General health, single item: 1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent.
- Table 2.
The Impact of Stepped Care on Structured Clinical Interview for DSM-IV–Positive Depressed Patients’ Self-Report of Depression and Receipt of Treatment
Outcome (n [%]) Stepped Care (n = 16) Control (n = 18) P* Self-reported depression after delivery 16 (100) 11 (61.1) .008 Received treatment (antidepressants, psychotherapy) 15 (93.8) 10 (55.6) .019 Received antidepressants 15 (93.8) 10 (55.6) .019 Received counseling 7 (43.8) 5 (27.8) 1.00 * Determined by one-way analysis of variance.
- Table 3.
Impact of Stepped Care Treatment for Postpartum Disorder on 9-Month Health, Work, and Duration of Treatment Outcomes
Outcomes Stepped Care (n = 16) Control (n = 18) P* PHQ-9 score† 9.0 (7.3) 7.6 (6.5) .597 Women with positive PHQ-9 (score ≥10) (n [%]) 7 (44) 5 (28) .475 Mental Health score‡ 18.8 (5.9) 20.7 (5.4) .356 General Health score§ 2.8 (1.0) 2.8 (0.6) .851 Number of illness days (within 2 weeks) Mother 3.3 (4.9) 2.6 (5.0) .869 Infant 1.1 (3.5) 1.9 (3.0) .466 Number of clinic/urgent care visits (within 2 weeks) Mother 0.2 (0.8) 0.2 (0.04) .972 Infant 0.1 (0.3) 0.6 (1.9) .407 Length of maternity leave (weeks)‖ 23.0 (12.7) 9.1 (4.8) .024 Number of hours spent at work during past week 34.0 (2.8) 35.0 (7.2) .861 Number of hours of missed work during past week 4.0 (5.7) 1.5 (2.1) .296 Impact of health problems on work productivity¶ 1.0 (1.4) 2.0 (2.4) .604 Impact of problems on regular activities¶ 3.9 (3.1) 2.4 (2.8) .562 Number of weeks of treatment 19.8 (11.5) 19.6 (12.8) .363 Women treated for ≥12 weeks (n [%]) 9 (75) 4 (67) .252 Number of counseling visits 5.3 (8.8) 2.3 (3.1) .131 Number of psychiatry visits 0.8 (2.1) 0.5 (0.8) .928 All values presented as mean (SD) unless otherwise indicated.
* Determined by one-way analysis of variance or χ2.
† PHQ-9 score range = 0 to 27, with higher numbers representing more depressive symptoms.
‡ Mental Health score range = 5 to 30, with higher numbers representing better mental health.
§ General health, single item: 1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent.
‖ The analysis on length of leave included only 2 stepped care subjects and 8 control subjects.
¶ Impact of health problems on work productivity or regular (non-job related) activities: scale of 0 to 10, where higher numbers represent greater negative health impact.
PHQ, Patient Health Questionnaire.
- Table 4.
Significant Differences in 9-Month Health Outcomes between the Treated Depressed Women, Untreated Depressed Women, and Nondepressed Women Self-Report Groups
Health Outcomes Depressed/Treated (n = 76) Depressed/Untreated (n = 46) Nondepressed (n = 344) F P* PHQ-9 score† 7.9 (6.2) 7.3 (5.1) 2.3 (2.8) 53.7 .000 Mental health score‡ 20.6 (4.9) 21.3 (4.2) 25.6 (2.9) 68.8 .000 General health score§ 3.0 (0.9) 3.3 (0.7) 3.8 (0.9) 129.6 .000 Number of illness days (within 2 weeks) Mother 3.3 (6.0) 2.3 (4.4) 1.3 (3.1) 3.7 .054 Infant 1.5 (3.1) 1.6 (3.2) 1.1 (2.6) 0.1 .820 Number of acute care visits (within 2 weeks) Mother 0.3 (1.5) 0.1 (0.4) 0.1 (0.5) 35.1 .000 Infant 0.4 (1.8) 0.2 (0.5) 0.2 (0.5) 0.5 .499 Impact of problems on regular activities‖ 3.2 (2.9) 2.0 (2.5) 1.0 (1.8) 14.7 .000 All values provided as mean (SD).
* Determined by analysis of covariance.
† PHQ-9 score range = 0–27, with higher numbers representing more depressive symptoms.
‡ Mental health score range = 5–30, with higher numbers representing better mental health.
§ General health, single item: 1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent.
‖ Impact of health problems on regular activities (unrelated to job), scale of 0–10, with higher numbers representing greater negative health impact.
PHQ, Patient Health Questionnaire.
Reason Mothers(n [%])† Mother thought she could handle it herself 21 (46) No time for depression visits 16 (35) Treatment not recommended 11 (24) Concerned about what others would think; embarrassed 10 (22) Concerned about medication effects on nursing infant 8 (17) Concerned about medication side effects on self 6 (13) Thought it was “just a phase” or a short-term problem 5 (11) No childcare available during depression visits 4 (9) Concerns about insurance and cost of coverage 4 (9) Concerned about becoming dependent on medications 3 (7) Husband/partner unsupportive of her getting help 1 (2) Worried that baby would be taken away 1 (2) * Self-diagnosed women (n = 46).
† Results show women who reported that they had been depressed but not treated.
