A Preventive Intervention for Pregnant Women on Public Assistance at Risk for Postpartum Depression

Abstract

Objective-Promising results were obtained in an earlier pilot study of a preventive intervention based on the principles of interpersonal psychotherapy to reduce the risk of postpartum major depressive disorder. In this study, the authors examined whether the intervention would reduce the risk of postpartum major depressive disorder in a larger sample of pregnant women.Method-Ninety-nine pregnant women on public assistance who were assessed to be at risk for postpartum depression were randomly assigned to receive standard antenatal care plus the intervention or standard antenatal care only. Diagnostic interviews were administered 3 months after delivery to assess for major depressive disorder.Results-Within 3 months after delivery, eight (20%) of the women in the standard antenatal care condition had developed postpartum major depressive disorder, compared with two (4%) in the intervention condition.Conclusions-This study provides further evidence for the efficacy of a brief intervention to reduce the occurrence of major depressive disorder among financially disadvantaged women during a postpartum period of 3 months.Postpartum major depressive disorder is a common illness with a high degree of morbidity, especially among low-income women (1). Several experts on this disorder have advocated for preventive interventions beginning in pregnancy (2, 3). In an earlier pilot study (4), we found that an intervention based primarily on the principles of interpersonal therapy appeared to be successful in preventing the occurrence of postpartum depression within 3 months after delivery among pregnant women on public assistance with at least one risk factor for postpartum depression. To date, ours is the only study on interventions aiming to reduce postpartum depression in at-risk pregnant women that has reported empirical support for an intervention. The lack of effect in other intervention studies is difficult to interpret because of methodological limitations, such as high attrition rate, lack of a standardized intervention, and an insufficiently high risk of postpartum depression among study subjects (5).Address correspondence to Dr. Zlotnick, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906; caron_zlotnick@brown.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptThe primary aim of this study was to examine whether participation in a program based primarily on interpersonal therapy could reduce the risk of postpartum depression during the first 3 months after delivery in a larger sample of pregnant women who were on public assistance and were at risk for postpartum depression. The ROSE Program (Reach Out, Stand strong, Essentials for new mothers) was designed to help mothers-to-be in an ethnically diverse population improve their close interpersonal relationships and change their expectations about them, build and use their social support networks, and master their role transition to motherhood. An emphasis on social relationships is especially relevant for l...

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