Detection and Care for Depression in the Perinatal Period Major depressive disorder (MDD) among women in pregnancy and the postpartum can have profoundly negative implications for women; fetal, infant, and child development; and the larger family. This mixed method study examines the detection and treatment of depression in a sample of high-risk women recruited during their first prenatal visit at one of two prenatal care sites chosen for diversity. One site serves a predominately white, married, insured population and the other a predominately African-American, unmarried, Medicaid population. The overarching goal is to identify influences on access and barriers to care for MDD in pregnancy and postpartum. Such influences include not only institutional, financial, provider, and practical issues, but often overlooked factors such as personal and cultural attitudes about depression, engagement with the medical system, competing priorities, and difficulties maintaining a focus on personal mental health during pregnancy and early motherhood, particularly for disadvantaged women. The research involves identifying a group of approximately 1600 women at high risk for MDD based on history of MDD, treatment for MDD, or current depressive symptomatology. These women will be assessed twice in pregnancy and twice postpartum for emergence of MDD. When these women meet criteria for MDD, they will be entered into a treatment monitoring protocol. This protocol involves systematically assessing symptom level, evidence of help-seeking, the detection of depression and offering of treatment by health providers, interactions with the health system, and the initiation of treatment and follow up care for depression. A targeted and purposively selected subsample of these women will also receive qualitative interviews to provide a more nuanced, comprehensive understanding of their responses to the quantitative assessments. Finally, a sample of maternal care providers will be interviewed to understand the provider's perspective on the process of identifying and obtaining treatment of depression. Results will show how design, implementation, and uptake and effective use of enhancements of care for depression in the perinatal period must be based on a realistic understanding of the full range of factors affecting the accessibility and acceptability of care and how these factors vary with the circumstances of women. This project examines the rates of detection of depression, quality of treatment received and outcomes achieved, and moderating factors of these in more than 1600 high-risk women recruited during their first prenatal visit. Results will show how design, implementation, and, importantly, uptake and effective use of enhancements of care for depression in the peripartum must be based on a more realistic understanding of the full range of factors affecting the accessibility and acceptability of care and how these factors vary with the circumstances of women.