Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study.
Psychiatr Serv. 2017 Nov 1;68(11):1164-1171. doi: 10.1176/appi.ps.201600411. Epub 2017 Jul 3.
Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD.
A randomized trial (September 2009 to December 2014) compared the MOMCare collaborative care depression intervention (choice of brief interpersonal psychotherapy or pharmacotherapy or both) with enhanced maternity support services (MSS-Plus) in the public health system of Seattle-King County. Among pregnant women with a probable diagnosis of major depression or dysthymia (N=164), two-thirds (N=106) met criteria for probable PTSD. Blinded assessments at three, six, 12, and 18 months postbaseline included the Symptom Checklist-20 depression scale and the Cornell Services Index. Analyses of covariance estimated gain in depression free days (DFDs) by intervention and PTSD status.
When the analysis controlled for baseline depression severity, women with probable depression and PTSD in MOMCare had 68 more depression-free days over 18 months than those in MSS-Plus (p<.05). The additional depression care cost per MOMCare participant with comorbid PTSD was $1,312. The incremental net benefit of MOMCare was positive if a DFD was valued at ≥$20.
For women with probable major depression and PTSD, MOMCare had significant clinical benefit over MSS-Plus, with only a moderate increase in health services cost.
MOMCare 从怀孕早期到产后 15 个月，为公共卫生系统中的医疗补助计划参保者提供围产期抑郁症的协作护理，其有效性已得到证实。MOMCare 对同时患有创伤后应激障碍（PTSD）的女性在降低抑郁和改善功能方面的影响大于没有 PTSD 的女性。本研究评估了 MOMCare 对患有重度抑郁症和 PTSD 的女性的增量效益、成本和净效益。
一项随机试验（2009 年 9 月至 2014 年 12 月）将 MOMCare 协作护理抑郁症干预（选择简短人际心理治疗或药物治疗或两者兼有）与西雅图-金县公共卫生系统中的增强产妇支持服务（MSS-Plus）进行了比较。在有重度抑郁症或心境恶劣障碍（N=164）可能诊断的孕妇中，三分之二（N=106）符合 PTSD 可能诊断标准。基线后 3、6、12 和 18 个月进行盲法评估，包括症状清单-20 抑郁量表和康奈尔服务指数。协方差分析估计了干预和 PTSD 状态对无抑郁日（DFD）的增益。
当分析控制了基线抑郁严重程度时，MOMCare 中患有 PTSD 的重度抑郁症女性在 18 个月内比 MSS-Plus 中无抑郁日多 68 天（p<.05）。每例伴有共病 PTSD 的 MOMCare 参与者额外的抑郁护理成本为 1312 美元。如果将 DFD 的价值设定为≥20 美元，那么 MOMCare 的增量净效益为正。
对于患有重度抑郁症和 PTSD 的女性，MOMCare 比 MSS-Plus 具有显著的临床获益，仅适度增加了医疗服务成本。
