Research That Matters (January 17 - 20, 2008)

Background and Purpose. Maternal depression during infancy has deleterious, lasting effects on infant and child well-being, on the mother's and father's mental health, and on the quality of their relationship. Depression during pregnancy has been repeatedly demonstrated to be one of the strongest predictors of postpartum depression (O'Hara & Swain, 1996). The overall aim of this randomized pilot study was to investigate the effects of using a brief, evidence-based psychotherapy -- brief Interpersonal Psychotherapy (IPT-B; 8 sessions; Swartz et al., 2004) to treat antenatal depression and prevent postpartum depression in pregnant, women on low incomes who attended an Ob/Gyn outpatient clinic in a large hospital in Pittsburgh, PA. In addition, IPT-B was enhanced to make it culturally relevant to women disadvantaged by race and/or poverty and to reduce racial and economic disparities in access to and engagement in mental health treatment. Methods. Using a randomized, controlled trial design, 53 pregnant African American and White women on low-incomes, were rated eligible to enter the study and randomly assigned to a pre-treatment engagement session and 8 weekly sessions of IPT-B (n=25) delivered on site in the Ob/Gyn clinic or to a referral to treatment-as-usual (TAU) at a behavioral health center located adjacent to the clinic (n=28). Both groups received written psychoeducational materials about depression. Primary inclusion criteria included 18 years or older, a score of > 13 on the Edinburgh Postnatal Depression Scale, 12-28 weeks gestation, fluent in English, and access to a household phone. Exclusion criteria included acute suicidal behavior, psychosis, organic problem, bipolar disorder, substance abuse/dependence within the past six months, or current intimate partner violence. Participants were assessed before and after treatment on depressive symptoms, depression diagnoses, anxiety symptoms, and social functioning. Data analyses included descriptive statistics and ANCOVA, using the intent-to-treat approach, with last observation carried forward. Results. Of the 25 women in the IPT-B condition, 21 out of 25 (84%) attended at least 4 treatment sessions and 17 out of 25 (68%) received a full course of treatment (7-8 sessions), compared to only 2 out of 28 (7%) in the TAU condition. At the post-treatment and 6-month postpartum assessments, intent-to-treat analyses showed that women in the IPT-B group displayed a significant reduction in depressive and anxiety symptoms, in depression diagnoses, and an improvement in social functioning, compared to those in the TAU group. Implications. Findings suggest that culturally relevant IPT-B may not only ameliorate antenatal depression and improve social functioning, but also may reduce racial and economic disparities in access to and engagement in mental health treatment. Based on the promising results of this pilot study, authors discuss potential dissemination of this model to more U.S. public care Ob/Gyn clinics serving women disadvantaged by race and/or poverty.