Towards reducing perinatal depression in inner-city Chicago:
An innovative approach
Michelle L.
1
Miller ,
Vesna
1
Psychiatry ,
University of Illinois at Chicago Department of
Abstract
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 during the 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 Model was 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 selfcare, 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.
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
1
Maki ,
Pauline M.
Brigham & Women's Hospital Department of
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
Objectives
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
2
Psychiatry
Population
Module Topic
Nutrition
Bonding
Exercise
Kit Name
Food & Mood
Bonding with Baby
It Starts with A
Step…
My Baby, My Mood,
Mood/Mindfulness
&I
Items in Kit
*Healthy Reminder Magnets
*Coupons for Fresh Fruit/Vegetables
*Containers for Sliced Fruit/Vegetables
*Refrigerator Picture Frame
*Keychain Picture Frame
*Fussy Baby Institute Pamphlets
*Canvas Bag
*Pedometer
*Water Bottle
*Handout on Exercise Myths
*Stress Ball
*Ocean Breeze Candle
*Lavender Candle
Upcoming Modules
Countering
Negative Stress
Improving Social
Managing
Assertiveness
Support
Stress
Sleep
Scheduling
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
Race
62% African American
30% Hispanic
6% Caucasian
1% Asian
1% Other
Results
Number of Patients
Number of Pregnant &
Number of Patients
Screened for Depression
Postpartum Patients
Screened for Depression
that Received a MotherCare
(N)
(N/%)
Kit (N/%)
PCC LAKE
382
353 (92.4%)
99 (28.0%)
PCC SALUD
701
682 (97.3%)
185 (27.1%)
Total
1,083
1,035 (95.6%)
284 (27.4%)
Problem
Solving
Evaluation Data
Evaluation Questions
The Stepped Care Model
Question #1
#2
#3
#4
5.66
5.72
Scale
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
Laura J.
2
Miller
MotherCare Kits
Background
Depression is common in peripartum
1
Pirec ,
1 = Strongly Disagree
2 = Moderately Disagree
Screening
No Depression
MotherCare Kit
if needed
No Depression
Step 1 Intervention
MotherCare Kit
Negative PHQ-9
1.MA distributes
PHQ-9
2.MA/Provider
scores PHQ-9
Assessment
Mild Major Depression
3.Physician/Nurs
e reviews PHQ-9
using assessment
tool
Positive PHQ-9
Step 2 Intervention
Guided Self-Care with
MotherCare Kit
Moderate Major
Depression
Step 3 Intervention
On-Site Mental Health Care
MotherCare Kit
Severe Major
Depression
Step 4 Intervention
Case Managed Referral
to Hospital/Specialized Facility
MotherCare Kit
Mean
4.25 5.28
No matter what I do, if I am going to get
1 sick, I will get sick.
2 I am in control of my health.
3 = Slightly Disagree
4 = Slightly Agree
5 = Moderately Agree
6 = Strongly Agree
Median
5
6
6
6
Range
1-6
1-6
4-6
4-6
I found the information in the 'Food and
3 Mood' Mother Care kit helpful.
I will use the Mother Care kit in the
4 future.
Conclusions
The Stepped Care Model allows for better recognition of peripartum mood changes
in primary settings
References
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.
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
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.
MotherCare Kits can be effective self-care guides for women at risk for perinatal
depression and may help reduce mild depressive symptomology
5. Illinois Pregnancy Risk Assessment Monitoring
System (PRAMS) Surveillance Report, 2005.
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.
6.Hawkins, J.W., Boston, C. (1998). Women's
reported self-care behaviors during pregnancy.
Health Care for Women International, 19(6), 529538.