Delivering perinatal depression care in a rural obstetric setting: a mixed methods analysis of feasibility, acceptability and effectiveness.

Abstract

Introduction: Many obstetric and primary care settings implement universal screening for depression during pregnancy and postpartum, yet mental health follow up rates are low in rural settings. Depression treatment integrated into obstetric settings allows for timely, evidence-based treatment of women with depression. Digital encounters such as text messages can further address barriers to care in perinatal women. Methods: We conducted an open treatment trial of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Pregnant and postpartum women who screened positive for depression participated. They received Problem Solving Therapy (PST) with or without antidepressants. A care manager (CM) coordinated communication between patient, obstetrician and psychiatric consultant. In between sessions, CMs communicated with patients by two way text messaging. We measured change in the Patient Health Questionnaire 9 (PHQ -9) score; and used surveys and focus groups to measure patient and provider satisfaction. We analyzed focus groups and text messaging content using qualitative analysis software. Results: Recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) were comparable to clinical trials in similar urban populations. The intervention, including text messaging was well accepted by providers and patients. Conclusions: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible, acceptable and effective. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression and text messages are a useful adjunct to this care.