frequent thoughts of self-harm (EPDS)24 or being better
off dead (PHQ-9)25 were recorded on a returned
questionnaire. Although necessary for patient safety,
these actions may have increased awareness of problems
among usual-care women that would potentially
bias our outcomes toward the null hypothesis. There
were no completed suicides during the study period.
Data on depression, dyad satisfaction, and maternal
anxiety were self-reported. Data for calculating rates
of postpartum depression diagnoses, therapy initiation, and referrals were obtained from medical record
review. Copies of all enrolled women’s medical records
were sent to the central site and abstracted by 3
trained and experienced nurse abstractors; interrater
reliability was assessed bimonthly.26