Advancing Evidence-Based Practice for Adolescent Perinatal Depression: Results From a Mixed-Methods Feasibility Study of Adapted Interpersonal Psychotherapy

Background and Purpose: The translation of empirically-supported interventions to practice settings serving low-income clients from different racial/ethnic and cultural backgrounds is challenging. Perinatal depression (PND) is a devastating public health problem and a leading cause of maternal morbidity and mortality associated with enduring negative child outcomes including death. Low-income, minority adolescents account for the highest estimates of PND (approximately 44%). Further, these mothers are less likely to utilize mental health services, and evidence to guide treatment in this population is severely limited. This escalates risks for sustained episodes of depression and increased rates of negative maternal and child outcomes including poverty, abuse, and neglect during and after pregnancy. To address this critical gap, we conducted a mixed methods, case-series study testing the feasibility of treating depression in pregnant adolescents using brief interpersonal psychotherapy (IPT-B). This study aimed to test and guide the cultural and developmental adaptation of this intervention for use among high-risk adolescent mothers.

Methods: We recruited pregnant, depressed adolescents from public health prenatal care clinics. Adolescents with severe domestic violence, psychotic disorders, bipolar disorder, or substance abuse/dependence were excluded. Prior to treatment, brief ethnographic interviews were conducted to obtain participants' perceptions of pregnancy, depression, mental health treatment and barriers to treatment. Participants received nine sessions of adapted IPT-B. Qualitative data was analyzed with NVivo7 using an iterative guided content analysis approach. We kept detailed records of recruitment, retention and case/supervision notes. Symptoms and functioning were measured pre-and post-treatment using: Center for Epidemiologic Studies Depression Scale (CES-D), Hamilton Rating Scale for Depression (HRSD), Edinburgh Postnatal Depression Scale (EPDS), Beck Anxiety Inventory (BAI), Social Adjustment Scale (SAS). Paired t-tests were used to test mean differences at baseline and post-treatment.

Results: In a sample of primarily African American (46.2%) and Latina (46.2%) adolescents, 81% of referred adolescents completed screening. Of these, 73% were eligible for the study. Among the eligible participants, 88% entered and 93% completed. Thirteen completers experienced significant (p<.01) decreases in depression (EPDS t(12)=4.4; CES-D t(12)=3.4; HRSD t(10)=3.5) and anxiety (BAI t(12)=3.3) and increased social adjustment (SAS t(12)=3.3) post-treatment. Qualitative findings revealed themes related to adolescents' desires for treatment and services for PND that informed additional adaptations to enhance the interventions cultural relevance and appropriateness for adolescents. Qualitative findings supported an ethnographic approach to individual treatment and increased case management services to meet the multiple and complex needs of these young mothers and their children.

Conclusions and Implications: Successful recruitment and retention of depressed, pregnant adolescents combined with significant, positive changes in depression, anxiety and social adjustment post-treatment support the feasibility and promise of treating adolescent perinatal depression using a culturally relevant, developmentally appropriate adaptation of IPT-B. Further intervention adaptations highlighted by the qualitative findings include: (a) involvement of family or kin, (b) additional components on parenting enhancement and the impact of trauma on interpersonal relationships, and (c) expansion of case management. The adaptations to IPT and the implications for practice and policy will be presented.