Gjerdingen Dwenda, Katon Wayne, Rich Deborah E
Department of Family Medicine & Community Health, University of Minnesota, St. Paul, MN 55103, USA.
Womens Health Issues. 2008 Jan-Feb;18(1):44-52. doi: 10.1016/j.whi.2007.09.001.
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.
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.
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.
Stepped care, a form of collaborative depression treatment, is proposed as a practical, cost-effective method for improving PPD diagnosis and clinical outcomes.
产后抑郁症（PPD）是最常见的严重产后并发症，是一种极具破坏性的疾病，不仅会对母亲产生负面影响，还会影响其婴儿、其他家庭成员以及工作表现。有大量研究致力于基于系统的质量改进措施，以治疗初级保健人群中的抑郁症；然而，此类研究很少针对产后人群。本文提出了一种基于医疗保健系统的质量改进模型，用于治疗PPD，该模型源自一般初级保健人群的研究成果。
使用以下术语在OVID/MEDLINE和PsychINFO中进行检索：抑郁症、产后抑郁症、大规模筛查、协作护理、逐步护理、心理治疗、认知行为疗法、人际治疗以及教育作为关键词。
本文所述的PPD管理模型包括筛查与诊断、启动积极治疗以及使用协作护理，协作护理包括初级保健就诊、个案管理员随访，对于复杂或困难病例，通过专科会诊或转诊提供更强化的护理。
逐步护理作为协作性抑郁症治疗的一种形式，被提议作为改善PPD诊断和临床结果的实用且具有成本效益的方法。
