Addressing Postpartum Depression Through Home Visiting: Examining an Integrated Approach to Identifying and Treating Postpartum Depression

Abstract

Home visiting clients with postpartum depression (PPD) are often referred to treatment. However, there is a significant gap between screening and treatment among this population. Clients who utilize home visiting services often have low socioeconomic status, increasing their barriers to treatment. This dissertation consists of three studies: a prevalence estimate of a cohort, a systematic review, and a Texas policy option analysis to answer the following:

(1) How many women in a home visiting program are identified to have depression at two, four, and twelve months? (2) What program factors are associated with increased treatment? What is the effectiveness of integrating a psychological intervention in a home visiting program on treatment of postpartum depression? (3) What policy alternative is cost-effective, improves intergenerational equity and access, is effective at diagnosing and treating postpartum depression, and a have low cost to the government?

Results from the studies indicate that the prevalence of PPD among Nurse-Family Partnership (NFP) home visiting clients is higher than the national average. The prevalence estimate study demonstrated a significant relationship between age at enrollment, annual income, the highest degree obtained, a previous history of depression, and PHQ-9 scores. An integrated psychological approach demonstrated substantially improved in alleviating depressive symptoms, reducing Major Depression Disorder (MDD) diagnoses, self-reported depressive symptoms, and clinician ratings of depressive symptoms and overall functioning. The Texas policy option analysis revealed that home visiting through NFP identifies high-risk mothers for PPD at a higher rate than the alternatives. NFP is an effective program that increases intergenerational equity and access, is cost-effective to the government and healthcare system, and has a high return on investment.

Further research is needed on how many visits are needed and the ideal duration of the intervention to achieve an optimal reduction of PPD symptoms. Additional consensus is needed on the validity of IH-CBT and PST4PPD to address PPD in home visiting models. Further data is needed to assess the trajectory of PPD in the home visiting population and the potential treatment options integrated within the NFP home visiting program.