The Hawthorne Effect and Maternal Depression Care

1
The Hawthorne Effect and Maternal Depression Care

• Research Advisors Jim Coyne, PhD
• Ian Bennett, MD, PhD
• Steve Marcus, PhD
• John Paul Julien
• University of Pennsylvania
• jjulien89_at_gmail.com

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Background

• A brief overview

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Major Depressive Disorder

• 4 16 of women experience depression during
  pregnancy
• Discontinued use of antidepressants when
  pregnant, increased rate of recurrence
• Difficult detection due to overlapping pregnancy
  symptoms

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Hawthorne Effect

• Observational phenomenon
• Highly debated amongst scholars
• Shown to alter patient and physician behaviors

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Pace (Pregnancy and Changing Emotions) Study

• 5R01MH081916-02 grant (P.I. James Coyne)
• Identify influences on access and barriers to
  care of major depressive disorder (MDD) for
  pregnant and postpartum women
• Mixed methods observational study
• Assess how social and institutional factors
  affect detection and treatment of maternal MDD

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Timeline of PACE Study
Start of PACE Study
End of PACE Study
Jan 2009- March 2009
Jan 2010 March 2010
July 2009
May 2013
Baseline maternal MDD rate
Comparison maternal MDD depression rate
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Project Goals
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Goals

• Determine whether or not Hawthorne Effect alters
  the detection and treatment of MDD in POGA
  practice
• Quantify the Hawthorne Effect
• Create baseline rate of depression detection
  before the PACE study

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Initial Work
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Initial work

• Learn the methodology of health services research
• Literature search
• Article analysis
• Understand bigger picture
• Obtaining Data
• Delivery Log abstraction
• Construct chart abstraction form
• Electronic medical record training
• Depression detection rate spreadsheet
• Writing projects
• Introduction to Hawthorne paper
• Methods section of Hawthorne paper

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Methods
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Methods

• Abstract 3 month period of deliveries from POGA
  delivery logs
• Use EPIC EMR medical records to view patient
  files
• Document depression diagnoses with chart
  abstraction form
• Obtain rate of depression detection and treatment
  through spreadsheet

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Work in Progress

• Completing documentation via EPIC medical records
• Quantifying rate of depression detection
• Determining whether or not there is a Hawthorne
  Effect

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Reflections

• A look back

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Special Thanks

• Jim Coyne, PhD
• Ian Bennett, MD, PhD
• Steve Marcus, PhD
• Jessica Rinaldi
• Laura Hanisch, PhD
• Steve Palmer, PhD

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References

• Halbreich U. Prevalence of mood symptoms and
  depressions during pregnancy implications for
  clinical practice and research. CNS Spectr.
  20049(3)177-184
• Kupfer DJ, Frank E, Perel JM, et al. Five-year
  outcome for maintenance therapies in recurrent
  depression. Arch Gen Psychiatry.
  199249(10)769-773
• Anita H. Clayton, MD. Considerations in Womens
  Mental Health Depression During Pregnancy.
  Primary Psychiatry. 200411(7)17-18
• Amici et al, Impact of the Hawthorne Effect in a
  Longitudinal Clinical Study The Case of
  Anesthesia, Controlled Clinical Trials 2000 21
  103-114.
• Rob McCarney, James Warner, Steve Iliffe,
  Robbert van Haselen, Mark Griffin Peter Fisher,
  The Hawthorne Effect a randomised, controlled
  trial, BMC Medical Research Methodology 2007 7
  30
• PH Feil, JS Grauer, CC Gadbury-Amyot, K Kula, MD
  McCunniff, Intentional use of the Hawthorne
  effect to improve oral hygiene compliance in
  orthodontic patients, Journal of Dental
  Education 2002 66 1129-1135.
• Rita Mangione-Smith, Marc N Elliott, Laurie
  McDonald, Elizabeth A McGlynn, An Observational
  Study of Antibiotic Prescribing Behavior and the
  Hawthorne Effect, Health Services Research
  200237,6 16031623.