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@gmail.com

2. Background A brief overview

3. 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

4. Hawthorne Effect Observational phenomenon Highly debated amongst scholars Shown to alter patient and physician behaviors

5. 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

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

7. Project Goals

8. 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

9. Initial Work

10. 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

11. Methods

12. 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

13. Work in Progress Completing documentation via EPIC medical records Quantifying rate of depression detection Determining whether or not there is a Hawthorne Effect

14. Reflections A look back

15. Special Thanks Jim Coyne, PhD Ian Bennett, MD, PhD Steve Marcus, PhD Jessica Rinaldi Laura Hanisch, PhD Steve Palmer, PhD

16. References Halbreich U. Prevalence of mood symptoms and depressions during pregnancy: implications for clinical practice and research. CNS Spectr. 2004;9(3):177-184 Kupfer DJ, Frank E, Perel JM, et al. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992;49(10):769-773 Anita H. Clayton, MD. Considerations in Women’s Mental Health: Depression During Pregnancy. Primary Psychiatry. 2004;11(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 2002;37,6: 1603–1623.