Introduction Cognitive behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6-week culturally tailored cognitive behavioral intervention offered to rural, minority, low-income women at risk for antepartum depression. Methods 146 pregnant women were stratified by high-risk for antepartum depression (Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher) or low-moderate risk (EPDS score of 4-9) and randomized to a cognitive behavioral intervention or treatment-as-usual. Differences in mean change of EPDS and BDI-II scores for low-moderate and high-risk women in the cognitive behavioral intervention and treatment-as-usual for the full sample were assessed from baseline (T1), post-treatment (T2) and 1-month follow-up (T3) and for African-American women in the subsample. Results Both the cognitive behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high-risk for depression (n=62), there was no significant treatment effect from T1 to T2 or T3 for the Edinburgh Postnatal Depression Scale. However, in low-moderate risk women, there was a significant decrease in the BDI-II scores from T1 to T2 (4.92 vs. 0.59, P=.018) and T1 to T3 (5.67 vs. 1.51, P=.04). Also, the cognitive behavioral intervention significantly reduced EPDS scores for African-American women at high-risk (n=43) from T1 to T2 (5.59 vs. 2.18, P=.02) and from T1 to T3 (6.32 vs. 3.14, P= .04). Discussion A cognitive behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment-as-usual, the cognitive behavioral intervention reduced depressive symptoms for African-American women at high-risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression. These promising findings need to be replicated in a larger clinical trial that incorporates methods to maintain greater participant engagement.

This exploratory study uses a nonprobability purposive sample to investigate the perceptions of domestic violence service providers in rural regions of North Carolina and Virginia. Investigators gathered data incorporating both quantitative and qualitative methods. Quantitative data were retrieved through the development and distribution of a self-administered survey targeting service provider perceptions about the general public, consumers of services, self-perceptions, and perceptions related to inter- and intra-agency issues. Qualitative data were collected to provide further elaboration on the topic through the use of a focus group composed of rural service providers. The focus group was facilitated by the investigators. Findings identified deficits in public knowledge, agency resources, and community resources, and professional development as being the most problematic issues. Victims were perceived as having to face multiple issues and barriers when seeking services. Implications of these findings are discussed as well as the need for continued research efforts.

Although there is a considerable body of knowledge about domestic violence, a limited proportion focuses on domestic violence in rural settings. Using a nonprobability purposive sampling technique, 93 providers of domestic violence services from rural and urban localities in North Carolina and Virginia were located and asked to complete a self-administered survey soliciting provider perceptions about service consumers, the general public, themselves, and inter- and intra-agency issues. Significant differences were observed between rural and urban providers about service consumer needs and experiences, perceptions about the general public, area resource availability, agency funding, provider training, and worker safety. Implications of these differences are discussed.

This pilot study evaluated the feasibility, effectiveness, and helpfulness of Insight-Plus, a brief culturally-tailored cognitive behavioral intervention for African-American and Caucasian rural low-income women at risk for APD [Edinburgh Postnatal Depression Scale (EPDS) > or = 10]. Forty two percent (63/149) of women in this non-randomized study were at risk for APD and 41% (26/63) of women, who met all eligibility criteria, initially agreed to participate. Seventeen participants completed all six intervention sessions. Ninety-four percent (16/17) who completed their one-month post-intervention interviews had an antepartum recovery rate of 81% (13/16, EPDS < or = 10). Participants reported that many aspects of the program were helpful and they continued to use the intervention exercises after the sessions ended.

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