Depression Attention for Women Now (The DAWN Study)
Depression Attention for Women Now (The DAWN Study)
Major depressive disorder (MDD) is a common disabling illness that disproportionately affects
 women, with prevalence rates two times those of men. In addition to suffering, MDD has been
 shown to have a marked effect on social and vocational functioning, with increased
 disability, lost productivity, and excess mortality. Women with MDD have an increased
 prevalence of comorbid anxiety disorders and medical conditions.

 Our model of care utilizes a social worker as a depression care manager (DCM) to support both
 patients and physicians in optimizing care in the OB-GYN clinical setting. This intervention
 will be compared to usual care for depression.
A large number of women receive their routine care in OB-GYN clinics, including a
 disproportionate percentage of low-income and minority women. For many of these women,
 OG-GYNs are the only provider they see on a regular basis. OB-GYNs take care of women across
 their lifespan, addressing gynecologic, health care maintenance, pregnancy and primary care
 concerns in their everyday practices. There are multiple aspects of OG-GYN care that are
 uniquely suited for detection and treatment of depression, but there are also significant
 barriers to such care that must be addressed.

 In this randomized controlled trial, we are testing this depression care management program
 for women attending two OB-GYN clinics in the University of Washington health care system.
 Our research aims to test the hypothesis that a depression care management intervention,
 integrated into the OB-GYN clinic setting, will improve treatment outcomes for depression,
 functional outcomes, and satisfaction with depression care. The results of our research will
 greatly impact clinical care by satisfying an unmet need for effective depression services
 for women seen in OB-GYN clinical settings.

 The study compares a depression care management intervention, delivered by a depression care
 manager, to usual care for depression in the clinics. The primary aims of the study are to
 evaluate, compared to usual care, a depression intervention consisting of enhanced education,
 engagement, and depression care management (with a choice of antidepressant medication
 monitoring and/or provision of brief psychotherapy).
Inclusion Criteria:

 -  PHQ-9 score ≥10 for Major Depressive Disorder (with 1 cardinal symptom) and/or ≥10 for
 Dysthymia (with 1 cardinal symptom)

 -  MINI confirmation of PHQ-9 diagnoses

 -  Access to a telephone

 -  English-speaking

 Exclusion Criteria:

 -  High suicide risk (PHQ-9 response)

 -  ≥2 prior suicide attempts

 -  Lifetime history of schizophrenia or bipolar disorder (MINI response)

 -  Substance abuse/dependence within the previous 3 months (CAGE-AID)

 -  Current severe intimate partner violence

 -  Currently seeing a psychiatrist