Home > Funded Projects > Prenatal Depression: Registry, Treatment Effectiveness to Reduce Preterm Delivery
Prenatal Depression: Registry, Treatment Effectiveness to Reduce Preterm Delivery
Project Number: R40 MC 25676 Grantee: Kaiser Foundation Hospitals Department/Center: Division of Research Project Date: 2/1/2013
De-Kun Li, MD, PhD Research Scientist 2000 Broadway Oakland, CA 94612-2304 Phone: (510) 891-3755 Email: firstname.lastname@example.org
Infancy (0-12 months)
Approximately 15-20% of pregnant women suffer from varying degrees of depression which has been associated with an increased risk of preterm delivery (PTD). Currently, significant confusion exists about if and how depression during pregnancy should be treated to reduce the risk of PTD due to the uncertain risk-benefit of antidepressant treatment. To determine (1) if untreated depression increases the risk of PTD, and thus should be treated, (2) if treatment is effective and beneficial, and (3) which treatment is most effective in reducing PTD, we propose to conduct a two-stage population-based prospective cohort study based on a unique infrastructure of a universal prenatal depression screening program in Kaiser Permanente Northern California (KPNC). Under this program, all pregnant women (about 33,000 annually) are screened for depression twice during pregnancy using the Patient Health Questionnaire (PHQ-9).
Taking advantage of this universal screening program, we will first identify more than
66,000 pregnant women who screen for depression during the study period to build a
prenatal depression registry (stage I sample). Using the information on depression
status and treatment choices collected in the registry, five cohorts will then be
established: (A) "Untreated cohort": those who screen positive for depression during
pregnancy, but without any treatment; (B) "Psychotherapy cohort": screen positive and
receive psychotherapy only; "Antidepressant cohort": screen positive and use
antidepressants only; (D) "Combination treatment cohort": screen positive and use both
psychotherapy and antidepressants; and "Control cohort": screen negative for
depression and do not receive treatment. Comparison of Cohort A versus Cohort E will
determine if untreated depression in pregnancy increases the risks of PTD.
Comparisons of Cohorts B, C and D to Cohort A, respectively, will determine the
effectiveness of depression treatment. Pair-wise comparisons among Cohorts B, C and
D will determine the relative risk-benefit of various treatment options including
antidepressants, psychotherapy, and combination therapies. We will also explore
whether the proposed relationships vary by race/ethnicity. To obtain more detailed
information on potential confounders, we will conduct Computer Assisted Telephone
Interviews (CATI) interviews among 2,000 stage II sample (400 randomly selected from
each of the five cohorts described above). Depression status and treatment options
(exposures), gestational age at delivery for PTD (outcome), and potential confounders
will be abstracted through both EMRs and CATI interviews. The Cox proportional
hazard regression model will be used to examine the effect of untreated depression
and, risk-benefit of various treatment options on PTD after controlling for underlying
depression severity (confounding by indication) and other confounders.
The objectives of the proposed study address MCHB Strategic Research Area 1 & 4.
The findings from the study will provide answers to pressing clinical questions of
whether depression in pregnancy should be treated and, if so, which option is the best
treatment choice in reducing PTD and improving pregnancy outcomes. Selecting an
effective treatment could lead to a reduction in PTD which remains the leading cause of
infant mortality and morbidity.
Depression, Mental Health & Wellbeing, Pregnancy, Preterm