Effectiveness of an Interpersonal Psychotherapy (IPT) Group Depression Treatment for Head Start Mothers: A Cluster-Randomized Controlled Trial

Background and Purpose: Maternal depression is a serious public health problem and can negatively impact children’s social emotional and cognitive development (Goodman et al., 2011; Pan et al., 2005). Rates of depression are higher among poor and racial/ethnic minority mothers (Wang et al., 2011), and this population often has less access to effective mental health treatment (Ertel et al., 2011) and may be wary of traditional mental health care because of the stigma (Anderson et al., 2006). The purpose of this study was to test whether an adaptation of an Interpersonal Psychotherapy – Group (IPT-G) for perinatal depression could be effective in reducing depressive symptoms of mothers whose children were enrolled in Head Start.

Methods: Participants were 119 mothers and their children, who were randomized by Head Start site to the study’s intervention (n=49) and control (n=70) groups. Mothers were 33.6 years of age on average (SD = 6.3), 81% were Latina, and 55% identified Spanish as their preferred language. Children were 4.2 years old on average (SD = 0.6) and the majority were boys. A 12-week IPT group was offered and therapists were supervised by the model developer. Mothers completed questionnaires on depressive symptoms (Center for Epidemiologic Studies Depression Scale; CES-D), parenting stress (Parenting Stress Index), social support (Duke-UNC Functional Social Support scale), parenting attitudes (Parental Behavior Inventory), and parent-child interaction (Keys to Interactive Parenting Scale) at intake, upon completion of the group, and at 6-month follow-up. To assess intervention effects, linear mixed-effect models (via SAS Proc Mixed) and generalized linear mixed-effect models (via SAS Proc Glimmix) were used to analyze whether the trajectories for continuous and dichotomized outcomes, respectively, differed between intervention and control conditions from baseline to 6-month follow-up.

Results: Participants in the treatment group showed a significant decrease in depression scores (β _time= - 4.59, p<0.05; p for time*group interaction p<0.05) compared to the control group. In the treatment group, CES-D scores declined on average from 20.3 at baseline to 14.4 at the 3-month follow-up, and then declining further at six-month follow-up. The intervention group also showed a significant improvement in parenting stress (β _time= - 6.77, p<0.05; p for time*group interaction <0.05), compared to the control group. The trajectories of change between the treatment and control groups did not significantly differ for the outcomes of maternal social support, parenting attitudes, or parent-child interaction. Lastly, dose-response effects of the intervention were observed for maternal depressive symptoms, parenting stress, confidant social support, and parental hostility.

Conclusions and Implications: This study supports the effectiveness of IPT-G in reducing depressive symptoms and parenting stress for a population of ethnic minority Head Start mothers. A strong dose effect was also evidenced, with mothers who attended more groups experiencing greater symptom reduction. These findings are particularly noteworthy since the sample was overwhelmingly Latina, with two-thirds being first generation immigrants. Future research should explore the null effects on parenting. Overall, findings suggest that IPT-G can be scaled within Head Start and also adapted to other settings that serve low income mothers.