Adapting Interpersonal Psychotherapy to Treat Perinatal Depression in Low-Income Adolescents: A Trauma Adapted Approach

Background: Perinatal depression (PND) is a leading cause of maternal morbidity/mortality associated with enduring negative maternal/child outcomes. Trauma history is often associated with PND. The highest estimates of PND (44%) and trauma history (82%) are found in low-income adolescent mothers. In fact, the strongest predictor of PND in adolescent mothers is trauma history.  PND increases adolescent mother’s risk of negative maternal/child outcomes including poverty, abuse, and neglect. Although PND disproportionately affects low-income, adolescent mothers, evidence to guide treatment is severely limited and few adolescents receive any mental health care. The adaptation of IPT is necessary to engage and successfully treat this population. We aimed to test the feasibility of treating adolescent PND with an adaptation of brief interpersonal psychotherapy (IPT-B) using a mixed-method, case-series study design.

Methods: Following established steps to adapt existing evidence-based interventions, we adapted IPT-B to treat depression in low-income, pregnant depressed adolescents receiving prenatal care in public health clinics. We adapted IPT based on existing literature and qualitative and quantitative data collected from the target population. We recruited 21 pregnant, depressed adolescents from public prenatal care clinics and, prior to treatment, brief ethnographic interviews were conducted to obtain participants’ perceptions of pregnancy, depression, and mental health treatment. 14 participants then received adapted IPT-B. Qualitative data was managed using NVivo7 and analyzed using an iterative guided content analysis approach. We kept detailed records of recruitment, retention and case/supervision notes. Symptoms of depression, anxiety, and functioning were measured pre-and post-treatment. Paired t-tests were used to test mean differences at baseline and post-treatment. We also conducted a prospective study of depression and trauma with 212 pregnant and postpartum adolescents to understand risk and protective factors for adolescent perinatal mental health.

Results: Results of the qualitative and prospective quantitative studies along with current research on trauma and neurodevelopment shaped the cultural, developmental, and trauma focused adaptation IPT-B. Feasibility results indicated that adapted IPT is a feasible intervention for perinatal depression in low-income adolescents. 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. However, traditional maintenance IPT did not appear to fully meet the postpartum needs of adolescent mothers and retention in maintenance treatment was poor.

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 of treating adolescent perinatal depression using IPT-BPA. Retention in maintenance sessions was poor indicating that traditional maintenance IPT may not meet the needs of adolescent mothers during the postpartum period. Suggestions for further adaptation of the maintenance sessions based on study findings will be presented. Social work research and practice focused on issues of adolescent pregnancy should account for the high estimates of depression and trauma history. Future research should carefully measure the developmental course of trauma history and incorporate neurodevelopment measures to assess for the severity of trauma’s impact on the brain and how this may increase risk of future depressive episodes.