Description of Momcare: Culturally Relevant Treatment Services for Perinatal Depression

Background and Purpose.  Depression during pregnancy has been repeatedly demonstrated to be one of the strongest predictors of postpartum depression (O’Hara & Swain, 1996) and was observed to increase the risk of preterm birth and low birth weight in a recent meta-analysis (Grote et al., 2010). The overall aim of this randomized controlled trial was to investigate the effectiveness of using an evidence-based, health services model of care, entitled “MOMCare,” to treat antenatal depression and prevent postpartum depression in pregnant, women on Medicaid who received Maternal Support Services in 10 public health centers in Seattle and King County, WA.  The MOMCare intervention used a collaborative care approach with the woman’s OB provider, and involved a choice of brief Interpersonal Psychotherapy (IPT-B; 8 sessions) or pharmacotherapy or both. It was specifically enhanced to reduce racial and economic disparities in access to and engagement in mental health treatment. More specifically the MOMCare intervention included a pre-treatment engagement session, based on principles of motivational interviewing and ethnographic interviewing to engage non-treatment seeking, socioeconomically disadvantaged, pregnant women with depression in treatment.  It also incorporated a case management component to address and help the woman meet her basic needs, such as food.  At the same time, interpersonal psychotherapy was enhanced to be relevant to the culture of race/ethnicity/nationality by incorporating ideas from the culturally centered framework of Bernal et al., 1995. 

Methods.  To date, 153 pregnant women from diverse racial/ethnic backgrounds have been randomly assigned to Care Plus (enhanced usual care), which consisted of a referral to the OB provider and/or to a community mental health center (n=81) or to MOMCare, which consisted of a pre-treatment engagement session, 8 weekly sessions of brief IPT and/or medication management, maintenance IPT and/or medication management, and case management (n=72). Both groups received written psycho-educational materials about depression.  Primary inclusion criteria were18 years or older, major depression or dysthymia as revealed on the PHQ-9, 12-32 weeks gestation, English-speaking, and access to a household phone.   Exclusion criteria included acute suicidal behavior, psychosis, organic problem, bipolar disorder, substance abuse/dependence within the past three months, or severe intimate partner violence.

Results.  Participants self-identified as 2.6% Native American, 5% Asian, 13.9% African American, 13.9% of mixed race, and 63% white, of whom 24.3% were Hispanic. 60% were single, 68% were unemployed, and 85.3 % had a high school degree or less. Clinician-rated data on PHQ-9 suggested that MOMCare significantly reduces antenatal depression from baseline to 3-months post-baseline and retains a majority of women in 8 IPT-B sessions. These results are inconclusive, however, until intent-to-treat analyses are conducted on objective data obtained from “blinded” assessments for both the MOMCare and Care Plus groups.

Conclusions and Implications. Preliminary findings suggest that a culturally relevant model of care (engagement session plus IPT-B) may not only ameliorate antenatal depression, but also may reduce racial and economic disparities in access to and engagement in treatment for perinatal depression.