Trauma Informed Interpersonal Psychotherapy for Adolescent Perinatal Depression: Achieving Equity through Evidence-Informed Models of Intervention

Background/Purpose: Perinatal depression (PND) is a significant social problem associated with enduring negative maternal/child outcomes. Further, PND increases risk of inequitable maternal/child outcomes including poverty, abuse, and neglect. Epidemic levels of both PND (33.2%) and trauma history (82%), are found in low-income adolescent mothers. Traumatic childhood events strongly predict perinatal depression in adolescent mothers. Although PND disproportionately affects low-income, adolescent mothers, evidence to guide treatment is limited and few adolescents receive evidence-based psychiatric care. Trauma-informed interventions are necessary to engage and successfully treat adolescent PND. This presentation details research examining the relationship between PND, trauma, and adolescent motherhood that resulted in the development of a trauma-informed adaptation of Interpersonal Psychotherapy (IPT).

Methods: Following established steps, we adapted Brief IPT to treat PND in low-income adolescents receiving prenatal care in public health clinics. Brief IPT (IPT-B) was adapted based on existing literature and studies of our target population. We recruited 21 pregnant, depressed adolescents and conducted brief ethnographic interviews to obtain participants’ perceptions of pregnancy, depression, and treatment. Fourteen participants received adapted IPT-B (IPT-BPA). Qualitative data was managed using NVivo7 and analyzed using an iterative, content analysis approach. Detailed recruitment, retention and case/supervision records were kept. Symptoms of depression, anxiety, and social functioning were measured pre-and post-treatment. Paired t-tests were used to test mean differences at baseline and post-treatment. In follow-up study, 224 pregnant adolescents aged 14-20 years were recruited from a public health prenatal clinic in the southeastern US. Interpersonal Trauma history was measured prenatally and postpartum. Analyses examined the prevalence of interpersonal trauma subtypes and polytraumatization. Relationships between interpersonal trauma and PND were examined using binary and multiple logistic regression.

Results: Feasibility results indicated that IPT-BPA is a feasible intervention for PND 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. Traditional maintenance IPT did not appear to fully meet the postpartum needs of adolescent mothers evidenced by poor treatment retention. Over 80% of participants reported interpersonal trauma (IPV=75%; caregiver loss=30%; child maltreatment=28.4%; Polytraumatization=64%). Childhood sexual abuse (0.204, p<0.01), childhood loss (0.199, p<0.01), and sexual IPV (0.139, p=0.060) were associated with increased risk of postpartum depression, partially mediated by antenatal depression (0.321, p<0.000).

Conclusion/Implications: Results of these qualitative and quantitative studies, along with current research on trauma and neurodevelopment shaped the trauma-informed adaptation of IPT-B. Successful recruitment and retention of depressed, pregnant adolescents combined with significant changes in depression, anxiety and social adjustment support the feasibility of treating adolescent PND using IPT-BPA. Maintenance session retention was challenging indicating traditional maintenance may not meet the needs of adolescents postpartum. To address psychiatric symptoms in pregnant adolescents trauma-informed models of care are necessary. Future research should test trauma-informed IPT-B for its effectiveness in reducing maternal psychiatric illness and improving infant outcomes. Additional research is also needed to carefully measure the developmental course of trauma history and incorporate neurodevelopmental measures to assess for impact on brain development and risk for depressive episodes.