Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy to Low-Income Adolescents with Perinatal Depression

Background and Purpose: Perinatal psychiatric disorders are a leading cause of maternal morbidity and mortality (Oates, 2003).  Of these, perinatal depression is the most prevalent; disproportionately affects low-income adolescent mothers; and is strongly associated with additional enduring negative maternal, child, and family outcomes, including sudden infant death syndrome (Howard, Kirkwood, & Latinovic, 2007;  Oates, 2003; Sarri & Phillips, 2004). Yet, evidence to guide the treatment of perinatal depression in adolescents is severely limited. Studies that account for the economic, cultural, and developmental needs of the most vulnerable mothers are virtually nonexistent (Bledsoe & Warrick, 2008). To address this critical gap, we conducted a pilot study testing the feasibility of an intervention providing culturally relevant, interpersonal psychotherapy (IPT-CRB; Grote et al, 2009) to depressed, pregnant adolescents in public health prenatal care clinics.

Methods: For this case series study, 15 participants were recruited from two public prenatal care clinics. To be eligible adolescents had to be pregnant, between 14-20 years of age, score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagovsky, 1987) and meet DSM-IV-TR criteria for major or minor depression. Adolescents were excluded if they met criteria for psychotic disorders, current substance abuse or dependence, or if they reported severe intimate partner violence, as these have been found to be counter-indicated with IPT-CRB (Grote et al, 2009). The intervention consisted of an engagement interview (Grote et al, 2007) and eight sessions of IPT-CRB (Grote et al, 009). Depressive symptoms were measured pre-and post-treatment using the EPDS (Cox et al; 1987). A paired t-test was conducted to examine differences in baseline and post-treatment depressive symptoms. We hypothesized that participants would have significantly lower levels of depressive symptoms post-treatment.

Results: Seventy-one percent of recruited adolescents met inclusion criteria. All eligible participants entered the study and 94% completed treatment. Study participants were young (mean = 17.2 years), primarily minority (50% Black, 30% Latina), and low-income (86% annual household income < $20,000). At baseline 100% were unemployed but only 50% were in school.  Participants who completed IPT-CRB experienced a decrease in depressive symptoms. Participants experienced an average decrease in EPDS scores of 8.2 points post-treatment with average post-treatment scores 5 points below the screening cut-point of 12.

 

	Mean EPDS	Standard Deviation	Significance
Baseline	15.2	(2.3)	p<.001
Post-treatment	7.0	(5.2)

Conclusions and Implications: Successful recruitment and retention of depressed, pregnant adolescents combined with initial findings that depressive symptoms decrease significantly post-treatment indicate IPT-CRB is a feasible and promising treatment for adolescent perinatal depression in a difficult to reach and vulnerable population of low-income adolescents. Findings are limited by the small sample size and the lack of a control group. A pilot randomized controlled trial is planned to validate pilot study findings.  If it is effective in this population, IPT-CRB could fill a critical gap in treatment for adolescents with perinatal depression and widespread implementation could ultimately serve to reduce maternal and infant health disparities associated with perinatal depression in pregnant adolescents.