Feasibility of Brief Hospital-Based Interventions for Postpartum Depression : Effects on Depressive Symptoms, Perceived Support, & Treatment Utilization

It is estimated that 10-20% of childbearing women develop postpartum depression (PPD), affecting up to 400,000 women in the United States each year. As many an 82% of women diagnosed with PPD decline recommended treatment, primarily due to a lack of knowledge about PPD, to societal stigma and to practical barriers. The objective of this study is to evaluate the feasibility of conducting a large-scale study examining the impact of screening measures and a supportive approach immediately postpartum on utilization of recommended care, levels of depression and perceived social support. Women were randomly assigned (N=40) on a maternity unit to one of four conditions. 1) treatment as usual (control), 2) PPD screening, 3) problem-solving support, and 4) PPD screening and problem-solving support. The three experimental groups also received brief education regarding depression and treatment effectiveness. A post-test at eight weeks postpartum involved a PPD screen, social support questionnaire, life events questionnaire and brief interview to assess utilization of care. An ANCOVA was used to assess whether or not treatment had an effect on screening scores, perceived support and recent life events after controlling for income as a covariate. Results indicated no significant differences between treatment and screen scores, perceived support or recent life events. Positive associations between income and social support scores and negative associations between income and recent life events were observed, suggesting that women of lower socioeconomic status are more likely to experience negative life events and perceive their support as being less adequate. Four women (10%) utilized treatment; of these four, two initiated antidepressants and had a history of treatment for depression. No significant differences were noted between the women who utilized treatment and the overall sample. Denial of treatment was related to fatigue, feeling overwhelmed and beliefs countering treatment. A model supporting the use of a standardized PPD brochure, routine screening immediately postpartum and at early pediatrician visits, prenatal education for both parents, home visits, and the use of a staff psychologist to treat postpartum women in a supportive environment through continuity of care is suggested. In addition, it is suggested that the results of this study be used to generate a second feasibility study utilizing the suggestions provided in this study. The results of a second feasibility study could be used to obtain funding for a large-scale study with adequate power, which could be used to support legislation to fund the proposed model