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Improving Outcomes for Low-Income Mothers With Depression

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03221556
Recruitment Status : Enrolling by invitation
First Posted : July 18, 2017
Last Update Posted : May 16, 2019
Sponsor:
Collaborators:
Patient-Centered Outcomes Research Institute
Boston University
Information provided by (Responsible Party):
Boston Medical Center

Brief Summary:
This is a randomized comparative effectiveness trial to improve outcomes among pregnant and post-partum women with symptoms of depression. Both interventions under study will be based in the patient-centered medical home setting at Boston Medical Center - specifically, in prenatal clinic or in the general pediatrics clinic. The study is a type 1 hybrid effectiveness-implementation trial of 230 mothers with clinically significant depressive symptomatology. Of the 230 subjects, half will receive the Engagement-Focused Care Coordination intervention; the other half will receive the Problem Solving Education intervention. Outcomes for mothers will be assessed every 2 months throughout a 12 month follow-up period. This trial is funded by a contract with PCORI, the Patient-Centered Outcomes Research Institute.

Condition or disease Intervention/treatment Phase
Post Partum Depression Behavioral: Engagement-Focused Care Coordination Behavioral: Problem Solving Education (PSE) Not Applicable

Detailed Description:

This is a type 1 hybrid effectiveness-implementation trial of 230 mothers with clinically significant depressive symptomatology being conducted at Boston Medical Center (BMC). The effectiveness component of the study (which is the trial registered on ClinicalTrials.gov) is a pragmatic, parallel group randomized trial that measures patient-reported outcomes over 12 months of follow-up. The implementation portion comprises a series of qualitative interviews to discern barriers and facilitators to intervention implementation.

The investigators will enroll 230 mothers with clinically significant depressive symptomatology according to the Edinburgh Postnatal Depression Scale (EPDS), a widely used screening instrument valid during pregnancy and in the postpartum period.

Engagement-Focused Care Coordination will be compared to Problem Solving Education (PSE). Whereas Engagement-Focused Care Coordination emphasizes referral to formal depression services following a brief engagement session, PSE offers initial depression treatment onsite, followed by referral to further care if depressive symptoms persist or worsen. Patients in both arms will have access to the same array of community-based mental health services upon referral. Both intervention arms are designed to be peer-delivered; thus, the investigators will enlist their existing team of PCMH family advocates - a group of women (approximately age-matched with our study participants) - to serve as intervention providers. To minimize contamination across comparators, this team will be divided into those trained in Engagement Interviewing and those trained in PSE.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 230 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Improving Outcomes for Low-Income Mothers With Depression: A Comparative Effectiveness Trial of Two Brief Interventions in the Patient-Centered Medical Home.
Actual Study Start Date : February 5, 2018
Estimated Primary Completion Date : March 2020
Estimated Study Completion Date : March 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Engagement-Focused Care Coordination
The brief intervention in Engagement-Focused Care Coordination is the Engagement Interview. In this model, providers meet one to two times with mothers who screen positive for depression, and use techniques of shared decision-making to help mothers process the results of the screen; explore treatment options; and connect with formal mental health services. Engagement-Focused Care Coordination emphasizes referral to formal mental health services.
Behavioral: Engagement-Focused Care Coordination
Engagement interviewing is embedded within a traditional PCMH structure using motivational interviewing and shared decision making; it explores treatment options in the context of a patient's life circumstances, and helps her work through ambivalence to receiving care. In one to two sessions, providers disclose the probable diagnosis of depression, provide psycho-education, present treatment options, and engage clients in shared decision making to determine the most appropriate referral.

Active Comparator: Problem Solving Education (PSE)
The brief Problem Solving Education (PSE) is a six-session cognitive-behavioral program. PSE offers immediate intervention in the PCMH, followed by referral to further treatment if symptoms persist.
Behavioral: Problem Solving Education (PSE)
Problem solving sessions are one-on-one, workbook-based interactions. Sessions comprise seven sequential steps: 1-defining a problem, 2-establishing goals for problem resolution, 3-generating multiple solution alternatives, 4-Implementing decision making guidelines, 5-evaluating and choosing solutions, 6-Implementing the preferred solutions, and 7-evaluating the outcome.




Primary Outcome Measures :
  1. Quick Inventory of Depressive Symptoms (QIDS SR-16) [ Time Frame: 2 months ]
    This scale is a 16-item self-report measure of depressive symptoms over the past 7 days. Each item is scored 0-3 (0 = no presence of the symptom; 3 = high burden of the symptom), yielding a total score range of 0 to 27. Because of its wide scoring range, the QIDS can be used to detect depressive illness in populations with low symptoms. Lower scores reflect less depressive symptoms.

  2. Quick Inventory of Depressive Symptoms (QIDS SR-16) [ Time Frame: 4 months ]
    This scale is a 16-item self-report measure of depressive symptoms over the past 7 days. Each item is scored 0-3 (0 = no presence of the symptom; 3 = high burden of the symptom), yielding a total score range of 0 to 27. Because of its wide scoring range, the QIDS can be used to detect depressive illness in populations with low symptoms. Lower scores reflect less depressive symptoms.

  3. Quick Inventory of Depressive Symptoms (QIDS SR-16) [ Time Frame: 6 months ]
    This scale is a 16-item self-report measure of depressive symptoms over the past 7 days. Each item is scored 0-3 (0 = no presence of the symptom; 3 = high burden of the symptom), yielding a total score range of 0 to 27. Because of its wide scoring range, the QIDS can be used to detect depressive illness in populations with low symptoms. Lower scores reflect less depressive symptoms.

  4. Quick Inventory of Depressive Symptoms (QIDS SR-16) [ Time Frame: 8 months ]
    This scale is a 16-item self-report measure of depressive symptoms over the past 7 days. Each item is scored 0-3 (0 = no presence of the symptom; 3 = high burden of the symptom), yielding a total score range of 0 to 27. Because of its wide scoring range, the QIDS can be used to detect depressive illness in populations with low symptoms. Lower scores reflect less depressive symptoms.

  5. Quick Inventory of Depressive Symptoms (QIDS SR-16) [ Time Frame: 10 months ]
    This scale is a 16-item self-report measure of depressive symptoms over the past 7 days. Each item is scored 0-3 (0 = no presence of the symptom; 3 = high burden of the symptom), yielding a total score range of 0 to 27. Because of its wide scoring range, the QIDS can be used to detect depressive illness in populations with low symptoms.Lower scores reflect less depressive symptoms.

  6. Quick Inventory of Depressive Symptoms (QIDS SR-16) [ Time Frame: 12 months ]
    This scale is a 16-item self-report measure of depressive symptoms over the past 7 days. Each item is scored 0-3 (0 = no presence of the symptom; 3 = high burden of the symptom), yielding a total score range of 0 to 27. Because of its wide scoring range, the QIDS can be used to detect depressive illness in populations with low symptoms. Lower scores reflect less depressive symptoms.


Secondary Outcome Measures :
  1. Beck Anxiety Inventory [ Time Frame: 2 months ]
    This scale is a 21-item self-report measure of anxiety in the past 7 days. Each item is scored 0-3 (0 = not at all; 3 = severely - it bothered me a lot), yielding a total score range of 0 to 63. The lower the score the less self-reported anxiety. It will be used to measure symptom relief.

  2. Beck Anxiety Inventory [ Time Frame: 4 months ]
    This scale is a 21-item self-report measure of anxiety in the past 7 days. Each item is scored 0-3 (0 = not at all; 3 = severely - it bothered me a lot), yielding a total score range of 0 to 63. The lower the score the less self-reported anxiety. It will be used to measure symptom relief.

  3. Beck Anxiety Inventory [ Time Frame: 6 months ]
    This scale is a 21-item self-report measure of anxiety in the past 7 days. Each item is scored 0-3 (0 = not at all; 3 = severely - it bothered me a lot), yielding a total score range of 0 to 63. The lower the score the less self-reported anxiety. It will be used to measure symptom relief.

  4. Beck Anxiety Inventory [ Time Frame: 8 months ]
    This scale is a 21-item self-report measure of anxiety in the past 7 days. Each item is scored 0-3 (0 = not at all; 3 = severely - it bothered me a lot), yielding a total score range of 0 to 63. The lower the score the less self-reported anxiety. It will be used to measure symptom relief.

  5. Beck Anxiety Inventory [ Time Frame: 10 months ]
    This scale is a 21-item self-report measure of anxiety in the past 7 days. Each item is scored 0-3 (0 = not at all; 3 = severely - it bothered me a lot), yielding a total score range of 0 to 63. The lower the score the less self-reported anxiety. It will be used to measure symptom relief.

  6. Beck Anxiety Inventory [ Time Frame: 12 months ]
    This scale is a 21-item self-report measure of anxiety in the past 7 days. Each item is scored 0-3 (0 = not at all; 3 = severely - it bothered me a lot), yielding a total score range of 0 to 63. The lower the score the less self-reported anxiety. It will be used to measure symptom relief.

  7. Patient Activation Measure [ Time Frame: 2 months ]
    This is a 13-item measure of patient knowledge, skill, and confidence for self-management. Each item is scored 1-4 (1 = strongly disagree; 4 = strongly agree), yielding a total score range of (13 to 52). Higher scores reflect more confidence in self-management and a better understanding of health conditions.

  8. Patient Activation Measure [ Time Frame: 4 months ]
    This is a 13-item measure of patient knowledge, skill, and confidence for self-management. Each item is scored 1-4 (1 = strongly disagree; 4 = strongly agree), yielding a total score range of (13 to 52). Higher scores reflect more confidence in self-management and a better understanding of health conditions.

  9. Patient Activation Measure [ Time Frame: 6 months ]
    This is a 13-item measure of patient knowledge, skill, and confidence for self-management. Each item is scored 1-4 (1 = strongly disagree; 4 = strongly agree), yielding a total score range of (13 to 52). Higher scores reflect more confidence in self-management and a better understanding of health conditions.

  10. Patient Activation Measure [ Time Frame: 8 months ]
    This is a 13-item measure of patient knowledge, skill, and confidence for self-management. Each item is scored 1-4 (1 = strongly disagree; 4 = strongly agree), yielding a total score range of (13 to 52). Higher scores reflect more confidence in self-management and a better understanding of health conditions.

  11. Patient Activation Measure [ Time Frame: 10 months ]
    This is a 13-item measure of patient knowledge, skill, and confidence for self-management. Each item is scored 1-4 (1 = strongly disagree; 4 = strongly agree), yielding a total score range of (13 to 52). Higher scores reflect more confidence in self-management and a better understanding of health conditions.

  12. Patient Activation Measure [ Time Frame: 12 months ]
    This is a 13-item measure of patient knowledge, skill, and confidence for self-management. Each item is scored 1-4 (1 = strongly disagree; 4 = strongly agree), yielding a total score range of (13 to 52). Higher scores reflect more confidence in self-management and a better understanding of health conditions.

  13. Coping Self-Efficacy Scale [ Time Frame: 2 months ]
    This 26-item scale measures perceived ability to cope with life challenges and comprises three factors: problem-focused coping (α=0.91), dealing with unpleasant emotions/thoughts (α=0.91), and getting support from family/friends (α=0.80). Each item is scored 0-10 (0 = cannot do at all; 10 = certain can do), yielding a total score range of 0 to 260. Higher scores reflect better ability to cope effectively with life's challenges.

  14. Coping Self-Efficacy Scale [ Time Frame: 4 months ]
    This 26-item scale measures perceived ability to cope with life challenges and comprises three factors: problem-focused coping (α=0.91), dealing with unpleasant emotions/thoughts (α=0.91), and getting support from family/friends (α=0.80). Each item is scored 0-10 (0 = cannot do at all; 10 = certain can do), yielding a total score range of 0 to 260. Higher scores reflect better ability to cope effectively with life's challenges.

  15. Coping Self-Efficacy Scale [ Time Frame: 6 months ]
    This 26-item scale measures perceived ability to cope with life challenges and comprises three factors: problem-focused coping (α=0.91), dealing with unpleasant emotions/thoughts (α=0.91), and getting support from family/friends (α=0.80). Each item is scored 0-10 (0 = cannot do at all; 10 = certain can do), yielding a total score range of 0 to 260. Higher scores reflect better ability to cope effectively with life's challenges.

  16. Coping Self-Efficacy Scale [ Time Frame: 8 months ]
    This 26-item scale measures perceived ability to cope with life challenges and comprises three factors: problem-focused coping (α=0.91), dealing with unpleasant emotions/thoughts (α=0.91), and getting support from family/friends (α=0.80). Each item is scored 0-10 (0 = cannot do at all; 10 = certain can do), yielding a total score range of 0 to 260. Higher scores reflect better ability to cope effectively with life's challenges.

  17. Coping Self-Efficacy Scale [ Time Frame: 10 months ]
    This 26-item scale measures perceived ability to cope with life challenges and comprises three factors: problem-focused coping (α=0.91), dealing with unpleasant emotions/thoughts (α=0.91), and getting support from family/friends (α=0.80). Each item is scored 0-10 (0 = cannot do at all; 10 = certain can do), yielding a total score range of 0 to 260. Higher scores reflect better ability to cope effectively with life's challenges.

  18. Coping Self-Efficacy Scale [ Time Frame: 12 months ]
    This 26-item scale measures perceived ability to cope with life challenges and comprises three factors: problem-focused coping (α=0.91), dealing with unpleasant emotions/thoughts (α=0.91), and getting support from family/friends (α=0.80). Each item is scored 0-10 (0 = cannot do at all; 10 = certain can do), yielding a total score range of 0 to 260. Higher scores reflect better ability to cope effectively with life's challenges.

  19. Parenting Stress Index - Short Form [ Time Frame: 2 months ]
    This 36-item scale yields scores on three subscales - "parental distress", "parent-child dysfunctional interaction", and "difficult child" - which combine to form the total stress scale. Each item is scored 1-5 (1 = strongly agree; 5 = strongly disagree), yielding a scoring range of 36 to 180. Higher scores reflect more parent stress.

  20. Parenting Stress Index - Short Form [ Time Frame: 4 months ]
    This 36-item scale yields scores on three subscales - "parental distress", "parent-child dysfunctional interaction", and "difficult child" - which combine to form the total stress scale. Each item is scored 1-5 (1 = strongly agree; 5 = strongly disagree), yielding a scoring range of 36 to 180. Higher scores reflect more parent stress.

  21. Parenting Stress Index - Short Form [ Time Frame: 6 months ]
    This 36-item scale yields scores on three subscales - "parental distress", "parent-child dysfunctional interaction", and "difficult child" - which combine to form the total stress scale. Each item is scored 1-5 (1 = strongly agree; 5 = strongly disagree), yielding a scoring range of 36 to 180. Higher scores reflect more parent stress.

  22. Parenting Stress Index - Short Form [ Time Frame: 8 months ]
    This 36-item scale yields scores on three subscales - "parental distress", "parent-child dysfunctional interaction", and "difficult child" - which combine to form the total stress scale. Each item is scored 1-5 (1 = strongly agree; 5 = strongly disagree), yielding a scoring range of 36 to 180. Higher scores reflect more parent stress.

  23. Parenting Stress Index - Short Form [ Time Frame: 10 months ]
    This 36-item scale yields scores on three subscales - "parental distress", "parent-child dysfunctional interaction", and "difficult child" - which combine to form the total stress scale. Each item is scored 1-5 (1 = strongly agree; 5 = strongly disagree), yielding a scoring range of 36 to 180. Higher scores reflect more parent stress.

  24. Parenting Stress Index - Short Form [ Time Frame: 12 months ]
    This 36-item scale yields scores on three subscales - "parental distress", "parent-child dysfunctional interaction", and "difficult child" - which combine to form the total stress scale. Each item is scored 1-5 (1 = strongly agree; 5 = strongly disagree), yielding a scoring range of 36 to 180. Higher scores reflect more parent stress.

  25. Child Behavior Checklist (CBCL-1.5/5) [ Time Frame: 2 months ]
    This 99-item scale assesses a range of internalizing and externalizing child behaviors for children 1.5-5 years. 67 items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. 32 items are scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems. Each item is scored 0-2 (0 = not true; 2 = very/often true), and one item is added by the parent/caregiver, yielding a total score range of 0 to 200. Lower scores are more favorable.

  26. Child Behavior Checklist (CBCL-1.5/5) [ Time Frame: 4 months ]
    This 99-item scale assesses a range of internalizing and externalizing child behaviors for children 1.5-5 years. 67 items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. 32 items are scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems. Each item is scored 0-2 (0 = not true; 2 = very/often true), and one item is added by the parent/caregiver, yielding a total score range of 0 to 200. Lower scores are more favorable.

  27. Child Behavior Checklist (CBCL-1.5/5) [ Time Frame: 6 months ]
    This 99-item scale assesses a range of internalizing and externalizing child behaviors for children 1.5-5 years. 67 items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. 32 items are scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems. Each item is scored 0-2 (0 = not true; 2 = very/often true), and one item is added by the parent/caregiver, yielding a total score range of 0 to 200. Lower scores are more favorable.

  28. Child Behavior Checklist (CBCL-1.5/5) [ Time Frame: 8 months ]
    This 99-item scale assesses a range of internalizing and externalizing child behaviors for children 1.5-5 years. 67 items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. 32 items are scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems. Each item is scored 0-2 (0 = not true; 2 = very/often true), and one item is added by the parent/caregiver, yielding a total score range of 0 to 200. Lower scores are more favorable.

  29. Child Behavior Checklist (CBCL-1.5/5) [ Time Frame: 10 months ]
    This 99-item scale assesses a range of internalizing and externalizing child behaviors for children 1.5-5 years. 67 items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. 32 items are scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems. Each item is scored 0-2 (0 = not true; 2 = very/often true), and one item is added by the parent/caregiver, yielding a total score range of 0 to 200. Lower scores are more favorable.

  30. Child Behavior Checklist (CBCL-1.5/5) [ Time Frame: 12 months ]
    This 99-item scale assesses a range of internalizing and externalizing child behaviors for children 1.5-5 years. 67 items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. 32 items are scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems. Each item is scored 0-2 (0 = not true; 2 = very/often true), and one item is added by the parent/caregiver, yielding a total score range of 0 to 200. Lower scores are more favorable.

  31. Collaborative Psychiatric Epidemiology Survey [ Time Frame: 2 months ]
    This 9-item survey will be used to measure engagement and retention with mental health services. It records all primary, specialty, and alternative sources of care.

  32. Collaborative Psychiatric Epidemiology Survey [ Time Frame: 4 months ]
    This 9-item survey will be used to measure engagement and retention with mental health services. It records all primary, specialty, and alternative sources of care.

  33. Collaborative Psychiatric Epidemiology Survey [ Time Frame: 6 months ]
    This 9-item survey will be used to measure engagement and retention with mental health services. It records all primary, specialty, and alternative sources of care.

  34. Collaborative Psychiatric Epidemiology Survey [ Time Frame: 8 months ]
    This 9-item survey will be used to measure engagement and retention with mental health services. It records all primary, specialty, and alternative sources of care.

  35. Collaborative Psychiatric Epidemiology Survey [ Time Frame: 10 months ]
    This 9-item survey will be used to measure engagement and retention with mental health services. It records all primary, specialty, and alternative sources of care.

  36. Collaborative Psychiatric Epidemiology Survey [ Time Frame: 12 months ]
    This 9-item survey will be used to measure engagement and retention with mental health services. It records all primary, specialty, and alternative sources of care.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Woman is pregnant and receives prenatal care at BMC; or is biological mother of 0 to 18-month-old child receiving care at BMC pediatric primary care clinic
  • Woman has EPDS score ≥ 10
  • Woman receives Medicaid insurance
  • Woman comfortable speaking and receiving information in English or Spanish
  • Woman has no current source of mental health care

Exclusion Criteria:

  • Woman under 18 years of age
  • Woman endorses suicidality
  • Woman exhibits signs of psychosis or is cognitively limited*

    • As part of the informed consent process, we will administer the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), which has been validated in populations of depressed and schizophrenic adults

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03221556


Locations
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United States, Massachusetts
Boston Medical Center
Boston, Massachusetts, United States, 02118
Sponsors and Collaborators
Boston Medical Center
Patient-Centered Outcomes Research Institute
Boston University
Investigators
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Principal Investigator: Michael Silverstein, MD MPH Boston University Medical Campus

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Responsible Party: Boston Medical Center
ClinicalTrials.gov Identifier: NCT03221556     History of Changes
Other Study ID Numbers: H-36434
AD-1603-34662 ( Other Grant/Funding Number: Patient-Centered Outcomes Research Institute )
First Posted: July 18, 2017    Key Record Dates
Last Update Posted: May 16, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: At the conclusion of the project study staff will create de-identified datasets and accompanying documentation (data dictionaries, annotated forms and manuals) to be used for data sharing. We will work in collaboration with the Boston University Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, which has a goal of maintaining datasets and collaborating on secondary analyses of clinical trials data.
Supporting Materials: Study Protocol
Informed Consent Form (ICF)
Time Frame: This will become available approximately one year after the conclusion of the project. We will make the data available indefinitely.
Access Criteria: Access will be determined by the BU Center for Clinical Translational Epidemiology and Comparative Effectiveness Research.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Boston Medical Center:
Comparative effectiveness research
Patient-centered medical home
Shared decision-making
Additional relevant MeSH terms:
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Depression, Postpartum
Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders
Puerperal Disorders
Pregnancy Complications