Discussion
depression, depressive, anxiety, depressive symptoms
We compared 2 strategies for the initial management of screen-detected depression among pregnant and postpartum patients. The study was designed to address an evidence gap in the USPSTF’s recommendation for depression screening. The comparison between EFCC and PSE answered the question whether providing peer-delivered cognitive behavioral therapy as an initial, postscreening depression treatment improved outcomes compared with coordinated referral to mental health services.Our results demonstrated that participants experienced at least moderately severe depression symptoms over one-third of the 12-month follow-up period. However, the rate of symptomatic person-time—for both depression and anxiety—was nearly identical across comparators. Toward the end of the follow-up period, depressive symptom scores appeared greater among those receiving PSE. This difference drove a statistically significant treatment × time interaction that demonstrated a difference in the trajectory of depressive symptoms favoring EFCC. We also detected significant treatment × time interactions for anxiety symptoms in a subset of models. These differential symptom trajectories, which we interpret as clearly present for depression but more equivocal for anxiety, did not appear to result from differential engagement with formal mental health care across comparators.