Description of Momcare: Culturally Relevant Treatment Services for Perinatal Depression
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.