Stepped care treatment of postpartum depression: a primary care-based management model

Womens Health Issues. 2008 Jan-Feb;18(1):44-52. doi: 10.1016/j.whi.2007.09.001.


Background and purpose: Postpartum depression (PPD), the most prevalent serious postpartum complication, is a devastating illness that negatively impacts not only the mother, but also her infant, other family members, and work performance. There is an extensive body of research addressing systems-based quality improvement efforts for treatment of depression in primary care populations; however, little of this research has been directed toward postpartum populations. This paper presents a health care systems-based quality improvement model for the treatment of PPD derived from research outcomes in general primary care populations.

Methods: OVID/MEDLINE and PsychINFO searches were performed using the following terms: depression, postpartum depression, mass screening, collaborative care, stepped care, psychotherapy, cognitive-behavioral therapy, interpersonal therapy, and education as keywords.

Main findings: The PPD management model described herein includes screening and diagnosis, initiation of active treatment, and use of collaborative care, which includes primary care visits, case manager follow-up, and more intensive care, through specialty consultation or referral, for complicated or difficult cases.

Conclusion: Stepped care, a form of collaborative depression treatment, is proposed as a practical, cost-effective method for improving PPD diagnosis and clinical outcomes.

Publication types

  • Review

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy / organization & administration
  • Depression, Postpartum / economics
  • Depression, Postpartum / therapy*
  • Family Practice / economics*
  • Female
  • Humans
  • Outcome Assessment, Health Care
  • Patient-Centered Care / organization & administration
  • Primary Health Care / economics
  • Primary Health Care / organization & administration*
  • Psychotherapy / organization & administration
  • Referral and Consultation / organization & administration
  • United States
  • Women's Health Services / economics
  • Women's Health Services / organization & administration*
  • Women's Health*