PRogram In Support of Moms: An Innovative Stepped-Care Approach for Obstetrics and Gynecology Clinics

NCT ID: NCT02760004

Last Updated: 2024-06-10

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

View full results

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

312 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-10-11

Study Completion Date

2022-05-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The primary goal of this study is to develop, evaluate, and share a new low-cost program for Obstetrics/Gynecology (Ob/Gyn) practices which will help to improve depression treatment for women during pregnancy and after childbirth.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Upwards of 1 in 5 women suffer from depression during pregnancy or within a year after giving birth. It has negative effects on birth outcomes, infant attachment, and children's behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Ob/Gyn practices need supports in place to adequately address depression in their patient populations. Thus, the Investigators developed and pilot tested the PRogram In Support of Moms (PRISM), to create a comprehensive intervention that is proactive, multifaceted, and practical. PRISM aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of stepped care, including training support and toolkits; and, (3) proactive treatment engagement, patient monitoring, and stepped treatment response to depression screening/assessment. PRISM builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings developed by our team. Because it uses existing infrastructure and resources, PRISM, has the potential to be feasible, sustainable, and transportable to other practice settings. The Investigators will compare PRISM vs. MCPAP for Moms which provides access to resource provision/referrals and psychiatric telephone consultation, in a clinical trial in which Investigators will randomize 10 Ob/Gyn practices to either PRISM or MCPAP for Moms (Massachusetts Child Psychiatry Access Program for Moms) - intervention. Patient participants will participate in either PRISM or MCPAP for Moms, depending on what intervention their practice is assigned to. The Investigators will compare the effectiveness of PRISM vs. MCPAP for Moms to improve depression severity and treatment participation in pregnancy through 13 months postpartum among 340 patients (n=170/group).

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Depression

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Participants

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Prism Intervention

PRogram In Support of Moms (PRISM)

Group Type EXPERIMENTAL

PRogram In Support of Moms (PRISM)

Intervention Type BEHAVIORAL

* Access to MCPAP for Moms
* PRogram In Support of Moms Toolkit with Stepped Care Algorithms
* Support clinic specific implementation using the Addressing Problems Through Organizational Change (APTOC) platform
* Customization of depression screening for each practice
* Proactively engage and track all women who screen +ve on the Edinburgh Postnatal Depression Scale(EPDS)
* Employ psychoeducation and Motivational Interviewing to engage patients with depression
* medical assistant champion and psychiatrist contact bi-weekly to review cases
* Stepped care treatment to depression screening/assessment

MCPAP for Moms Intervention

MCPAP for Moms (Massachusetts Child Psychiatry Access Program for Moms)

Group Type EXPERIMENTAL

MCPAP for Moms

Intervention Type BEHAVIORAL

* 30-60 minute presentation on perinatal depression
* Access to telephonic psychiatric consultation with MCPAP for Moms perinatal psychiatrist for Ob/Gyns
* Access to Ob/Gyn provider assessment and treatment recommendations via one-time face-face MCPAP for Moms psychiatrist patient evaluation
* Access to assessment and treatment protocols in Provider Toolkit
* Resource provision/referrals

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

PRogram In Support of Moms (PRISM)

* Access to MCPAP for Moms
* PRogram In Support of Moms Toolkit with Stepped Care Algorithms
* Support clinic specific implementation using the Addressing Problems Through Organizational Change (APTOC) platform
* Customization of depression screening for each practice
* Proactively engage and track all women who screen +ve on the Edinburgh Postnatal Depression Scale(EPDS)
* Employ psychoeducation and Motivational Interviewing to engage patients with depression
* medical assistant champion and psychiatrist contact bi-weekly to review cases
* Stepped care treatment to depression screening/assessment

Intervention Type BEHAVIORAL

MCPAP for Moms

* 30-60 minute presentation on perinatal depression
* Access to telephonic psychiatric consultation with MCPAP for Moms perinatal psychiatrist for Ob/Gyns
* Access to Ob/Gyn provider assessment and treatment recommendations via one-time face-face MCPAP for Moms psychiatrist patient evaluation
* Access to assessment and treatment protocols in Provider Toolkit
* Resource provision/referrals

Intervention Type BEHAVIORAL

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Rapid Access to Perinatal Psychiatric care in Depression

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

1. Female
2. Age 18-55 years
3. English speaking
4. \>4 weeks Gestational age (GA) until 4 months postpartum
5. Receiving care from one of the 10 participating practices (five will participate in PRISM (intervention group) and five will have access to MCPAP For Moms (comparison group)
6. Edinburgh Postnatal Depression Scale score (EPDS) ≥10
7. Able to communicate in written and spoken English; and
8. Cognitively able to participate in informed verbal consent

Exclusion Criteria

1. Lack of verbal and written English fluency
2. Under age 18 or over age 55
3. substance use disorder as determined by the questions in 4 Ps questionnaire
4. Screen positive for bipolar disorder via the Mood Disorder Questionnaire (MDQ)
5. Prisoner
6. Women participating in 'Moms do care' study
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of Massachusetts, Worcester

OTHER

Sponsor Role lead

Centers for Disease Control and Prevention

FED

Sponsor Role collaborator

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Nancy Byatt

Associate Professor of Psychiatry and Obstetrics & Gynecology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Nancy Byatt, DO, MS, MBA

Role: PRINCIPAL_INVESTIGATOR

University of Massachusetts Medical School/UMass Memorial Health Care

Tiffany A Moore Simas, MD, MPH, MEd

Role: PRINCIPAL_INVESTIGATOR

University of Massachusetts Medical School/UMass Memorial Health Care

Jeroan J Allison, MD, MS

Role: PRINCIPAL_INVESTIGATOR

University of Massachusetts Medical School/UMass Memorial Health Care

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

UMass Medical School/UMass Memorial Medical Center

Worcester, Massachusetts, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

References

Explore related publications, articles, or registry entries linked to this study.

Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000 Nov;157(11):1873-5. doi: 10.1176/appi.ajp.157.11.1873.

Reference Type BACKGROUND
PMID: 11058490 (View on PubMed)

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782-6. doi: 10.1192/bjp.150.6.782.

Reference Type BACKGROUND
PMID: 3651732 (View on PubMed)

Chen H, Wang J, Ch'ng YC, Mingoo R, Lee T, Ong J. Identifying mothers with postpartum depression early: integrating perinatal mental health care into the obstetric setting. ISRN Obstet Gynecol. 2011;2011:309189. doi: 10.5402/2011/309189. Epub 2011 Sep 15.

Reference Type BACKGROUND
PMID: 21941662 (View on PubMed)

Flynn HA, O'Mahen HA, Massey L, Marcus S. The impact of a brief obstetrics clinic-based intervention on treatment use for perinatal depression. J Womens Health (Larchmt). 2006 Dec;15(10):1195-204. doi: 10.1089/jwh.2006.15.1195.

Reference Type BACKGROUND
PMID: 17199460 (View on PubMed)

Burton A, Patel S, Kaminsky L, Rosario GD, Young R, Fitzsimmons A, Canterino JC. Depression in pregnancy: time of screening and access to psychiatric care. J Matern Fetal Neonatal Med. 2011 Nov;24(11):1321-4. doi: 10.3109/14767058.2010.547234. Epub 2011 Jan 24.

Reference Type BACKGROUND
PMID: 21261444 (View on PubMed)

Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt). 2010 Mar;19(3):477-90. doi: 10.1089/jwh.2008.1352.

Reference Type BACKGROUND
PMID: 20156110 (View on PubMed)

Glavin K, Smith L, Sorum R, Ellefsen B. Redesigned community postpartum care to prevent and treat postpartum depression in women--a one-year follow-up study. J Clin Nurs. 2010 Nov;19(21-22):3051-62. doi: 10.1111/j.1365-2702.2010.03332.x. Epub 2010 Aug 19.

Reference Type BACKGROUND
PMID: 20726926 (View on PubMed)

Glavin K, Smith L, Sorum R. Prevalence of postpartum depression in two municipalities in Norway. Scand J Caring Sci. 2009 Dec;23(4):705-10. doi: 10.1111/j.1471-6712.2008.00667.x. Epub 2009 Aug 29.

Reference Type BACKGROUND
PMID: 19490523 (View on PubMed)

Chaudron LH, Kitzman HJ, Peifer KL, Morrow S, Perez LM, Newman MC. Prevalence of maternal depressive symptoms in low-income Hispanic women. J Clin Psychiatry. 2005 Apr;66(4):418-23. doi: 10.4088/jcp.v66n0402.

Reference Type BACKGROUND
PMID: 15816782 (View on PubMed)

Delucchi KL, Tajima B, Guydish J. Development of the Smoking Knowledge, Attitudes, and Practices (S-KAP) Instrument. J Drug Issues. 2009 Mar;39(2):347-364. doi: 10.1177/002204260903900207.

Reference Type BACKGROUND
PMID: 20717496 (View on PubMed)

McDonald SD, Calhoun PS. The diagnostic accuracy of the PTSD checklist: a critical review. Clin Psychol Rev. 2010 Dec;30(8):976-87. doi: 10.1016/j.cpr.2010.06.012. Epub 2010 Jul 6.

Reference Type BACKGROUND
PMID: 20705376 (View on PubMed)

Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.

Reference Type BACKGROUND
PMID: 16717171 (View on PubMed)

Swanson LM, Flynn HA, Wilburn K, Marcus S, Armitage R. Maternal mood and sleep in children of women at risk for perinatal depression. Arch Womens Ment Health. 2010 Dec;13(6):531-4. doi: 10.1007/s00737-010-0177-z. Epub 2010 Jul 14.

Reference Type BACKGROUND
PMID: 20628772 (View on PubMed)

Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. 2012 Jun 20;12:36. doi: 10.1186/1471-244X-12-36.

Reference Type BACKGROUND
PMID: 22546012 (View on PubMed)

Cooper LA, Brown C, Vu HT, Palenchar DR, Gonzales JJ, Ford DE, Powe NR. Primary care patients' opinions regarding the importance of various aspects of care for depression. Gen Hosp Psychiatry. 2000 May-Jun;22(3):163-73. doi: 10.1016/s0163-8343(00)00073-6.

Reference Type BACKGROUND
PMID: 10880709 (View on PubMed)

Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986 Dec;51(6):1173-82. doi: 10.1037//0022-3514.51.6.1173.

Reference Type BACKGROUND
PMID: 3806354 (View on PubMed)

Heitjan DF. Annotation: what can be done about missing data? Approaches to imputation. Am J Public Health. 1997 Apr;87(4):548-50. doi: 10.2105/ajph.87.4.548. No abstract available.

Reference Type BACKGROUND
PMID: 9146428 (View on PubMed)

Myers ER, Aubuchon-Endsley N, Bastian LA, Gierisch JM, Kemper AR, Swamy GK, Wald MF, McBroom AJ, Lallinger KR, Gray RN, Green C, Sanders GD. Efficacy and Safety of Screening for Postpartum Depression [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Apr. Report No.: 13-EHC064-EF. Available from http://www.ncbi.nlm.nih.gov/books/NBK137724/

Reference Type BACKGROUND
PMID: 23678510 (View on PubMed)

Weathers F, Litz B, Huska J, Keane T. PTSD checklist-civilian version. In. Boston: Nation Center for PTSD. Behavioral Sciences Division. ; 1994

Reference Type BACKGROUND

Little R. Statistical Analysis with Missing Data. New York: John Wiley and Sons; 1987

Reference Type BACKGROUND

Karlson K, Holm A. Decomposing primary and secondary effects: A new decomposition method. Research in Social Stratification and Mobility 2011;29:221-37.

Reference Type BACKGROUND

Julce C, Flahive J, Lightbourne T, Podila S, Mahanna A, Zimmermann M, Sheldrick RC, Moore Simas TA, Byatt N. Descriptive Characteristics of Psychiatric Medication Discontinuation Among Perinatal Women With Depressive Symptoms. Early Interv Psychiatry. 2025 Jun;19(6):e70070. doi: 10.1111/eip.70070.

Reference Type DERIVED
PMID: 40539750 (View on PubMed)

Byatt N, Brenckle L, Sankaran P, Flahive J, Ko JY, Robbins CL, Zimmermann M, Allison J, Person S, Moore Simas TA. Effectiveness of two systems-level interventions to address perinatal depression in obstetric settings (PRISM): an active-controlled cluster-randomised trial. Lancet Public Health. 2024 Jan;9(1):e35-e46. doi: 10.1016/S2468-2667(23)00268-2.

Reference Type DERIVED
PMID: 38176840 (View on PubMed)

Schipani Bailey E, Byatt N, Carroll S, Brenckle L, Sankaran P, Kroll-Desrosiers A, Smith NA, Allison J, Simas TAM. Results of a Statewide Survey of Obstetric Clinician Depression Practices. J Womens Health (Larchmt). 2022 May;31(5):675-681. doi: 10.1089/jwh.2021.0147. Epub 2021 Sep 2.

Reference Type DERIVED
PMID: 34491103 (View on PubMed)

Masters GA, Brenckle L, Sankaran P, Person SD, Allison J, Moore Simas TA, Ko JY, Robbins CL, Marsh W, Byatt N. Positive screening rates for bipolar disorder in pregnant and postpartum women and associated risk factors. Gen Hosp Psychiatry. 2019 Nov-Dec;61:53-59. doi: 10.1016/j.genhosppsych.2019.09.002. Epub 2019 Oct 22.

Reference Type DERIVED
PMID: 31710859 (View on PubMed)

Moore Simas TA, Brenckle L, Sankaran P, Masters GA, Person S, Weinreb L, Ko JY, Robbins CL, Allison J, Byatt N. The PRogram In Support of Moms (PRISM): study protocol for a cluster randomized controlled trial of two active interventions addressing perinatal depression in obstetric settings. BMC Pregnancy Childbirth. 2019 Jul 22;19(1):256. doi: 10.1186/s12884-019-2387-3.

Reference Type DERIVED
PMID: 31331292 (View on PubMed)

Provided Documents

Download supplemental materials such as informed consent forms, study protocols, or participant manuals.

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

Access external resources that provide additional context or updates about the study.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1436349

Comparing regression coefficients between models using logit and probit: a new method. Available online at Social Science Research Network, 2010. (Accessed Accessed August, 2011)

http://papers.ssrn.com/sol3/papers.cfm?abstractid=1730065

Total, direct, and indirect effects in logit models. 2010. (Accessed Accessed August, 2011

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

1U01DP006093

Identifier Type: NIH

Identifier Source: secondary_id

View Link

H00009163

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.