Major depression affects women twice as often as men over the lifetime. Women’s highest rates of depression occur during reproductive and menopausal transitions. Additionally, more than one-third of obstetrics-gynecology (OB/GYN) patients use their OB/GYN physician as their primary care provider, particularly those with limited income and limited or no health insurance. However, OB/GYN physicians often have less training in depression than other primary care physicians.
In addition, markers of social disadvantage (lack of health insurance, low income, unemployment, lower educational attainment, and single parenthood) are related to higher rates of depression and anxiety, as well as more persistent depression. The Depression Among Women Now (DAWN) study was conducted to determine whether collaborative depression care in an OB/GYN setting was as effective in treating socially disadvantaged women with no health insurance or public coverage as it was in treating women with commercial insurance.
The DAWN intervention included hiring a social worker at two different OB/GYN clinics to assist in overcoming barriers to care, such as lack of transportation and housing issues. Social workers provided an initial engagement session that has been shown to improve rates of mental health follow-up care, as well as follow-ups by phone or in person every 1 to 2 weeks for 12 months. During weekly meetings, a social worker, a psychiatrist, and an OB/GYN physician recommended medication and behavioral treatment plans.. One of the clinics was a county-hospital-based clinic that mostly treated a socially disadvantaged population, and the other was a university-based OB/GYN clinic that treated a mixed socioeconomic population.
The DAWN intervention was found to be more effective than usual care for patients with no health insurance or public coverage. Intervention patients had improvements in depression treatment, as well as improvements in depressive symptoms and functioning during the 18 months following the 12-month-long intervention. Additionally, results were similar for both clinics, despite differences in the socioeconomic status of their patients.
Follow The Academy Portal in November for additional information on the use of integrated behavioral health care in the OB/GYN setting.
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