Michelle L. Miller 1 , Vesna Pirec 1 , Pauline M. Maki 1 , Laura J. Miller 2

1. Towards reducing perinatal depression in inner-city Chicago: An innovative approach Michelle L. Miller1, Vesna Pirec1, Pauline M. Maki1, Laura J. Miller2 University of Illinois at Chicago Department of Psychiatry1, Brigham & Women's HospitalDepartment of Psychiatry2 Abstract Population MotherCare Kits BACKGROUND: Depression, poor physical well-being, and lack of self-care are highly prevalent problems for women during pregnancy and postpartum. The UIC Illinois Mother Care Project works within the Chicago community, specifically in two women’s health clinics (PCC Lake & PCC Salud) that treat high-risk, minority women duringthe perinatal period. The project’s central goals are to improve perinatal mental health outcomes by utilizing the Stepped Care Model and the MotherCare Kit. The Stepped Care Model identifies women who are at risk for perinatal depression. MotherCare Kits are interventions that aim to reduce mild depressive symptoms, prevent further exacerbation of perinatal depression, and help perinatal women with their physical well-being. METHODS: The Stepped Care Modelwas created to increase rates of screening, assessment, and treatment of uncomplicated depression in peripartum in a primary care clinic. The protocol for the project involved PCC personnel administering a screening tool for depression (the PHQ-9) during pregnancy and postpartum. If a woman screened positive, a MotherCare Kit was given; a MotherCare Kit was also given if the provider believed it would benefit the patient. MotherCare Kits are toolkits that contain psychosocial, CBT-based booklets and themed props that provide a self-care guide for women in the areas of mental and physical health. Four differently themed modules have been created, all with the underlying goal of showing women how to practice self-care, prevent depressive symptoms and help women take care of their physical well-being. RESULTS: MotherCare Kits began to be given out in February of 2010 to PCC Salud and in August of 2010 to PCC Lake; 550 total MotherCare Kits have been given to PCC Salud and PCC Lake. The data show 1,035 (95.6%) of prenatal patients at PCC Lake & PCC Salud have been screened for depression and 284 (27.4%) of those patients that were screened for depression have received a MotherCare Kit. Evaluations were completed for the first module, ‘Food & Mood’, with phone evaluations. Currently, evaluations on the other modules are being collected. Evaluations of the MotherCare Kit show women finding them useful, having a feeling of control over their health and a plan to use the information on physical and mental health in the future. CONCLUSIONS: Based on evaluations collected, application of the MotherCare Kits contents that focus on preventing depression and increasing physical well-being appear to be an effective intervention during the perinatal period; they encourage women to practice self-care, feel in control of their well-being, and possibly prevent depressive symptomology. • PCC Community Wellness Centers • -Non-profit health network Chicago surrounding community • -Serves approximately 2,500 perinatal women annually • -69% of families below the federal poverty level • -54% Utilize Medicaid and 16% are Uninsured • -UIC operates the system at two of the nine PCC Centers in Chicago • -PCC Salud has a primarily Hispanic population • -PCC Lake has a primarily African American population Results Background Upcoming Modules • Depression is common in peripartum • Estimated period prevalence: • 9.4 – 12.7% during pregnancy • 21.9% during the first year postpartum1 • 50% relapse rate during pregnancy for women with previous history2 • Untreated maternal perinatal depression can adversely affect mother-infant interactions and increase the risk of emotional, cognitive and behavioral problems in their children3 • The pre-pregnancy obesity rate of women in 2002-2003 was 22% 4 • The percentage of postpartum women in Illinois (2005) who were overweight/obese that reported being depressed was 23.8% 5 • Assessing self-care behaviors early in pregnancy may show who can benefit from self-care education and have a healthier pregnancy 6 Evaluation Data The Stepped Care Model Negative PHQ-9 MotherCare Kit if needed No Depression Screening 1.MA distributes PHQ-9 2.MA/Provider scores PHQ-9 3.Physician/Nurse reviews PHQ-9 using assessment tool Step 1 Intervention MotherCare Kit No Depression Conclusions Step 2 Intervention Guided Self-Care with MotherCare Kit References Assessment Mild Major Depression Objectives 1. Gaynes, B.N., Gavin, N., Meltzer-Brody, S. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment #119. 2. Kemp, C. (2006). R elapse of major depression in pregnant women. AAP News, 27, 4. 3. Cogill, S.R., Caplan, H.L., Alexandra, H. (1986). Impact of maternal postnatal depression on cognitive development of young children. British Medical Journal, 292:1165-1167. 4. Kim, S.Y., Dietz, P.M., England, L. et al (2007). Trends in pre-pregnancy obesity in nine states, 1993 – 2003. Obesity (Silver Spring) 15:986-993. 5. Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) Surveillance Report, 2005. 6.Hawkins, J.W., Boston, C. (1998). Women's reported self-care behaviors during pregnancy. Health Care for Women International, 19(6), 529-538. • The Stepped Care Model allows for better recognition of peripartum mood changes in primary settings • Receiving a MotherCare Kit and implementing its’ modules may improve women’s control over health, facilitate self care, and prevent onset or exacerbation of mood symptoms and/or poor physical well-being • MotherCare Kits can be effective self-care guides for women at risk for perinatal depression and may help reduce mild depressive symptomology Step 3Intervention On-Site Mental Health Care MotherCare Kit Moderate Major Depression • Implement an integrated stepped-care system to improve detection and eventually treatment of women with depressive symptoms in peripartum in primary settings • Improve self-care for women in peripartum to either prevent or help with mild depressive symptomology and perinatal depression by using the MotherCare Kit • Evaluate effectiveness of the MotherCare Kit Positive PHQ-9 Step 4 Intervention Case Managed Referral to Hospital/Specialized Facility MotherCare Kit Severe Major Depression