A Randomized Controlled Trial of Dyadic-Interpersonal Psychotherapy in a Low-Income Population with Perinatal Depression

Background: Perinatal depression is a major public health burden impacting both mothers and their offspring. To date, treatments focused on reducing maternal depressive symptoms alone, while important, have not been sufficient to ameliorate risk to infants. The goal of this study was to extend brief-Interpersonal Psychotherapy delivered during pregnancy by including a post-partum attachment based dyadic-component to further maintain mother’s treatment gains and enhance the mother-infant relationship (called IPT-Dyad). The current report presents preliminary evidence from a pilot randomized controlled trial comparing IPT-Dyad to Enhanced Treatment as Usual (ETAU).

Methods: Pregnant women, ages 18 and older, between 12-30 weeks gestation with singleton pregnancies were recruited from an urban prenatal clinic.  Women scoring 10 or higher on the Edinburgh Depression Scale with a principal diagnosis of MDD, Dysthymia, or Depression NOS were eligible. Eligible participants were randomized to either IPT-Dyad (n=21) or ETAU (n=21). IPT-Dyad visits were held in participants’ homes or the university clinic and consisted of 9 weekly individual sessions of Brief Culturally Relevant IPT based on the Grote model. Postpartum sessions consisted of continued use of the IPT framework coupled with mother-infant therapy drawing from IPT, attachment based interventions, and developmental education with the goal to prevent relapse of maternal depressive symptoms, solidify the mother-infant relationship and enhance infant emotional development. Participants in ETAU received community referrals and assistance with social services plus regular contact with study staff.  The Edinburgh Depression Scale and feasibility and acceptability metrics were the primary outcomes. Other self-report and observational measures of infant behavior and parenting were also collected. Because of the small sample size effect sizes and confidence intervals will be presented.

Results: Participants were primarily African American (77%), single (80%), with an average age of 26. Over 80% of participants reported incomes below the Federal poverty level. About half of participants met criteria for PTSD. On average, participants assigned to IPT-Dyad attended 6 sessions (range 0-16) during pregnancy and 8 sessions (range 0-24) postpartum. Participants in IPT-Dyad reported being highly satisfied with the intervention. Over 50% of ETAU participants reported receiving some form of psychotherapy or antidepressant medication. Overall attrition was low during pregnancy in both groups (10%) but significantly increased postpartum to almost 30% in the IPT-Dyad group and 40% in the ETAU group. Depression scores clinically significantly improved from baseline in both groups and remained improved over the 12 month follow-up. Outcomes were similar in both groups on other outcome measures as well.

Implications: IPT-Dyad is a promising intervention for perinatal depression with potential benefit for mothers and babies.  Despite efforts to overcome common barriers to treatment, treatment engagement remained a challenge throughout the perinatal period, especially postpartum. It was also a challenge to balance attending to the high psychosocial needs of the families versus more intensive focus on optimizing mother-infant interactions. More work is needed to engage under-resourced populations in perinatal depression care. Earlier screening and intervention; better integration of care within OB settings; delivering care in conjunction with social service resources; and technology may improve uptake.