T- BOOM Teens--Building Options and Opportunities for Moms

Depression during the perinatal period is a major public health concern. Postpartum
depression (PPD) causes personal and family suffering at a time when adaptation to
parenthood is critical. Successful interventions for treating depression in medical
settings have been framed by a chronic disease management model. The key ingredient to
success is a dedicated care manager who provides education and support to patients, actively
coordinates care, and thereby improves treatment outcomes for patients. Compared to
interventions in medical office settings, telephone care management positioned at the level
of the health plan offers a systematic and efficient mechanism for ongoing treatment support
of women with PPD, particularly in a geographically dispersed population.

We propose to conduct a comprehensive project to improve treatment outcomes for depressed
postpartum women through adaptation of the depression care management model used in primary
care settings. The major components are: 1) depression screening in a population of
postpartum adolescents, 2) depression education for all who screen positive, 3) a diagnostic
interview to evaluate for depressive disorders in mothers who score above and below a
defined threshold on the screening instrument, 4) telephone-based care management
intervention, and 5) longitudinal evaluation across the first year post-birth for depression
and maternal and child public health outcomes. Focus groups will precede the major study
components. A focus group of adolescent mothers will inform the investigators about the
barriers to depression care management that encompass resource needs, acceptability of
interventions to cope with stress or depression, and access to care. A separate focus group
of community professionals of representatives from agencies or groups that provide community
supports and health services will be used to explore the perceptions of barriers to care for
new adolescent mothers. All participants in this project will be eligible for mental health
services through their health plans that serve Medicaid and commercial members.

We plan to identify 125 child or adolescent new mothers with PPD. The child or adolescent
new mothers will be assigned to depression care management. They will be supported in
making choices about depression treatment (after receiving education about options),
encouraged to access their preferred treatment (through the direct discussion of barriers
and solutions), counseled to comply with treatment recommendations, and assisted to
problem-solve if failure to respond occurs. All participants will have systematic
evaluations at 3, 6, and 12 months post-birth. Outcomes include not only maternal
depressive symptom levels but also functional and public health outcomes for mothers,
families, and infants. We have developed a multi-disciplinary team with expertise in
clinical research with depressed and minority women and health services to address these
needs.

Inclusion Criteria:

- Adolescent mothers age < 17 years 364 days at birth of index infant

- Live born infants

- Parents/guardian of the young mother must be available and competent to provide
consent to the enrollment of the young mother

- The young mother may provide assent for her own enrollment.

- Ethical need for awareness of the possible risks, benefits and alternatives to
enrollment in this study.

- Mothers with an EPDS>/=10 or CES-D>/=16 (suggest increased risk for major depression)

- Mothers with major depressive disorder (MDD) regardless of their EPDS or CES-D
scores. These are patients with high risk for severe recurrence of depressive
symptoms in the postpartum. We will assess their outcomes in this study.

- Adolescent mothers with an EPDS<10 OR CES-D<16 (screen negative) without MDD will be
interviewed by phone with the KIDDIE-SADS mood screen to screen for all categories of
major diagnoses AND the Mood Disorders Module

Exclusion Criteria:

- No access to a telephone Screening and depression care management are accomplished by
phone; mothers with no phone are referred to Magee social work for other services

- NON-English-speaking Measures are in English

- The multiple questionnaires and measures are in English