Grant: Operating Grant

Last year over 49,000 Canadian mothers experienced depression in the first year following childbirth, putting at least 80,000 children at risk for poor developmental outcomes. International experts have clearly identified exposure to maternal depression as a major childhood adversity and have suggested that effective interventions to address this condition are one of the most important preventive strategies we can implement to reduce long-term negative developmental outcomes among children. Unfortunately, postpartum depression often remains undetected and untreated. Collaborative care is an approach to treatment that is highly effective for the management of depression in primary care settings. Part of the success of this approach is that it actively promotes treatment initiation and adherence while addressing patient preferences and perceived barriers. However, this approach has not been evaluated for the treatment of postpartum depression and no systematic or evidence-based approach for postpartum depression management in primary care exists in Canada. The purpose of this trial is to evaluate the effect of a collaborative care intervention on postpartum depression among mothers attending well-child visits in an early childhood primary care practice. Women with depressive symptomatology will be randomly allocated to either an intervention group (usual postpartum care plus collaborative care) or a control group (usual postpartum care). A research assistant blinded to group allocation will telephone all mothers at 6, 9, and 12 months post-randomization to collect maternal outcome data; child outcome data will be obtained from trained staff at each practice. The study is novel, important, and timely, as it will provide data to advance our understanding of how to deliver optimal mental health care for mothers in the postpartum period while also offering information about how improving depression treatment outcomes serve to prevent adverse outcomes in children.