Psychiatric episodes, depression levels, medication side effects, and concomitant drug therapy were recorded at each visit. The PRIME-MD Patient Health Questionnaire (6
) was used to confirm the primary diagnosis. Depression severity was assessed with the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms Version (SIGH-ADS) (7
). The SIGH-ADS comprises the 21-item Hamilton Rating Scale for Depression (8
) and an additional set of eight questions to probe for neurovegetative symptoms, which are commonly reported by women with depression. A SIGH-ADS score of ≤8 indicates a euthymic mood state, and a score of ≥18 indicates a higher level of depression severity that may be accompanied by impaired functioning. The team developed a client satisfaction survey—a self-report tool to assess a participant’s experience. On a 5-point Likert scale, women rate the quality of time spent with the staff, the explanations about their health concerns, their inclusion in the treatment decision-making process, the instructions they received for follow-up, and their overall care.
The depression screening identified 29 women with increased depression risk (EPDS ≥10), and all agreed to enter the CARES program. Sixteen women arrived for initial evaluations, and thus the evaluation participation rate was 55%. The average age of participants was 25 years (range 18–36 years). Fourteen were African American, and two were white. Twelve were single, and four were married. Twelve had no insurance, and four were covered by Medicaid (which expires for mothers at six weeks after delivery). Each participant had a primary diagnosis of major depressive disorder—15 had unipolar disorder, and one had bipolar disorder. Eleven had moderate or severe depression symptoms. Six women had comorbid posttraumatic stress disorder, three had comorbid alcohol or cannabis abuse disorders, and 12 had two or more comorbid medical disorders.
At baseline and the first and second follow-up visits, the mean±SD SIGH-ADS scores were 18±8 (range 8–33), 17±9 (range 0–28), and 11±8 (range 4–19), respectively. Eight participants returned for at least one follow-up visit after the evaluation (drop-out rate of 50%). Participants reported high levels of satisfaction (mean score 33±3; range 28–35; possible range of 0 to 35, with higher scores indicating greater satisfaction.)
The eight participants who began receiving treatment and returned for follow-up care reported that the combined treatment (medication and skills training) reduced their symptoms and improved their functioning at home and work. They found that the skills enriched their moment-to-moment mother-infant interactions.
Six of the sixteen participants required treatment for sustained traumatic grief related to environmental stressors from violence. They reported sadness, nightmares, hyperarousal, and feelings of unresolved loss related to the death of beloved family members. One woman’s three-year-old son had died after accidentally shooting himself with his father’s gun. One woman’s adult son died as the result of a drive-by shooting. One woman witnessed the murder of her husband on her doorstep. Inventory tools to assess the intensity of symptoms related to grief and bereavement-specific symptoms (yearning for the deceased, disbelief, and not accepting the death) allowed clinicians to help participants define goals to reduce the intensity of their grief, improve recall of fond memories, and reintegrate with the community (9