Home Visits of Motivational Interviewing and Problem Solving Therapy to Target Perinatal Depression: A Pilot Study

Background and Purpose: Depression during or after pregnancy poses serious threats to maternal, child and family functioning and is preventable with proper treatment. Research indicates that African -American mothers may experience higher rates of prenatal depression than other ethnicities even when SES is controlled for. Depression before or during pregnancy is one of the strongest predictors of postpartum depression. Social workers often work with low-income pregnant mothers, yet knowledge of simple yet empirically sound strategies for decreasing perinatal depression is lacking in social work practice. Authors present data from a pilot study designed to adapt a Problem Solving Therapy (PST) with an added Motivational Interviewing (MI) component to target depression during pregnancy. Outcomes on depression and feasibility of implementation in community based agency are presented.

Methods: We conducted a phase 1 pilot study that used a one group pre-test, post-test design to test the promise and feasibility of the MI+PST home visiting intervention. Case workers (n=3) recruited pregnant, depressed mothers within their family services program. Women in first trimester and with serious mental illness were excluded. Participants received an initial session of MI and 4 sessions of PST adapted from a primary care model (Hegel & Arean, impact-uw.org). PST is effective in lowering depression among populations with high levels of stress and negative life events, low levels of SES and can be delivered by non-mental health professionals if needed. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS) and PHQ-9. Paired t-tests were used to test mean differences in depressive scores at baseline and post-treatment. Research assistants conducted structured interviews with case workers and participants. Content analysis was used to sort feedback on recruitment, retention, efficacy of program and suggestions for improvement of cultural fit. We kept detailed records of recruitment issues and case notes.

Results:In an African-American sample 92% completed all sessions of the intervention. Average annual household income was less than 10K, most were unmarried and held high school degree. Participants experienced significant decreases in depression symptoms (EPDS t(11)=3.26, p<.05; and severity: PHQ-9 t(11)=4.28, p<.05. Qualitative findings among case workers revealed high satisfaction with the intervention and 100% adherence to delivery of intervention despite time constraints and limited administrative support. Case workers reported that the MI session helped them to build rapport at a faster rate than typical among a population they characterize as hard to instill trust within. Mothers reported increased coping skills, high levels of satisfaction with intervention and continued use of PST to manage stressors up to 4 months post treatment.

Conclusions and Implications: Successful recruitment and retention of depressed, pregnant, low income African-American mothers combined with significant decreases in depression support the feasibility and promise of treating perinatal depression in a home visiting intervention of MI + PST. Suggestions for future implementation included:  (a) education of depression prevention among family members and, (b) expansion of case management and increased sessions. Receptivity to intervention during pregnancy suggests a need for intervention that spans from pregnancy to postpartum. Practice and research implications are discussed.