Identifying and treating maternal depression in underserved, African-American and Latino women in a pediatric primary care setting
The Foundation's initiative, Finding Answers: Disparities Research for Change, was designed to use research and evaluation to test hypothetical solutions for reducing racial and ethnic disparities in health care settings and actual disparity reduction outcomes in ongoing programs.Inner-city women experience significant disparities in the diagnosis and treatment of depression. A significant link exists between childhood behavioral health concerns and maternal depression. The purpose of this project is to evaluate the effectiveness of a program, housed in a pediatric primary care setting, designed to improve detection and treatment of inner-city women with depression. These women will be identified through the screening and detection of behavior problems in their toddlers. The project has a randomized-controlled trial study design. Approximately 750 toddlers will be screened for behavioral health problems and environmental risks during well-child visits to the Yale Primary Care Center. If screens are positive, a behavioral health clinician will conduct a clinical interview, and baseline screens for depression will be administered using the Quick Inventory of Depressive Symptomatology scale. Eligible subjects who score >8 will be randomized to receive on-site cognitive behavioral therapy or intensive case management. Clinicians blinded to group status will obtain baseline Clinical Global Impressions (CGI) scores. Data for all subjects examining depression status, child behavioral health problems and parenting stress will be collected at baseline, every two weeks during intervention, immediately after intervention and two months later. In terms of the primary outcome, improvement in depressive symptoms as measured by changes in the Quick Inventory of Depressive Symptomatology and Clinical Global Impressions will be compared between the randomized groups. Changes in behavioral health problems in toddlers and in parenting stress will be compared in mothers who did or did not achieve remission from their depressive disorders. This project holds the potential to reduce racial/ethnic disparities in the treatment of depression by using a novel approach to increase mothers' readiness for treatment if they believe it may help their children and treatment is offered in a trusted setting.
Amount Awarded $202,976.00
Awarded on: 11/28/2006
Time frame: 12/1/2006 - 12/31/2009
Grant Number: 59747