Date of Award

Spring 5-2019

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

CATHERINE L. TROISI, PHD

Second Advisor

BEATRICE J. SELWYN, SCD

Third Advisor

LUCY J. PURYEAR, MD

Abstract

Postpartum depression is a common complication of childbirth and is often underdiagnosed although it affects about 13-15% of new mothers (O’Hara and Swain, 1996; Munk-Olsen et al., 2006). To improve detection and treatment for postpartum depression, four obstetric clinics in Houston, Texas were trained to use the Edinburgh Postnatal Depression Scale (EPDS) to screen women for postpartum depression at the 6 week postpartum visit. The purpose of this study was to evaluate compliance with screening women for postpartum depression at the 6 week postpartum visit, with referring women that score at-risk to the women’s reproductive mental health clinic, and with treating at-risk women referred to the women’s reproductive mental health clinic in two service delivery models - co-located and integrated. The co-located model refers to 3 obstetric clinics and the women’s reproductive mental health clinic being located within a single building, while the integrated model refers to a women’s reproductive mental health provider being embedded inside of a single obstetric clinic. Postpartum women presenting for a 6 week postpartum visit at four obstetric clinics in Houston, Texas from October 1, 2014 – September 30, 2016 were included in the study and their outcomes were traced across the continuum of the training protocol from screening, referral to care and treatment at the women’s reproductive mental health clinic. The integrated service delivery model screened women at the 6 week postpartum visit significantly more than the co-located service delivery model (p < 0.001) and was 62% more likely to refer women at-risk of postpartum depression to the women’s reproductive mental health. There was not a significant difference in getting women into treatment between the two service delivery models; however, when considering outcomes of the protocol and off protocol findings, the rate of women getting into treatment is higher in both models compared to what has been reported in the literature (Rowan P. , Greisinger, Brehm, Smith, & McReynolds, 2012) (Horowitz & Cousins, 2006).

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