A promising new model of care for postpartum depression: A randomised controlled trial of a brief home visitation program conducted in Houston, Texas, USA

Abstract

Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 -15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well-child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non-Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five-session home visitation program using the Problem-Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self-efficacy. Based on these results, a short-term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms.

Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis

“…Among these interventions (), nine were delivered during the antenatal period (Cho et al, 2008; Silverstein et al, 2011; Hayden et al, 2012; Ammerman et al, 2013; Burns et al, 2013; Dimidjian et al, 2014, 2016; Yazdanimehr et al, 2016; Nejad et al, 2021), followed by postnatal ( n = 8) (Chabrol et al, 2002; Cooper et al, 2003; Morrell et al, 2009; Hou et al, 2014; Ngai et al, 2015; Kordi et al, 2018; Van Horne et al, 2021) and both periods ( n = 7) (Prendergast and Austin, 2001; McKee et al, 2006; Rahman et al, 2008; O’Mahen et al, 2013a; Trevillion, 2014; Rahman et al, 2018; Tandon et al, 2018; Sikander et al, 2019b). Eleven interventions were delivered in communities, especially through home visits (Prendergast and Austin, 2001; Chabrol et al, 2002; Cooper et al, 2003; Rahman et al, 2008; Morrell et al, 2009; Ammerman et al, 2013; Burns et al, 2013; Tandon et al, 2018; Sikander et al, 2019a; Van Horne et al, 2021), three in multiple settings (McKee et al, 2006; Silverstein et al, 2011; Dimidjian et al, 2017), while the rest were delivered in healthcare settings (clinic or hospital) (Cho et al, 2008; Hayden et al, 2012; O’Mahen et al, 2013a; Hou et al, 2014; Trevillion, 2014; Ngai et al, 2015; Dimidjian et al, 2016; Yazdanimehr et al, 2016; Kordi et al, 2018; Nejad et al, 2021). A higher proportion of studies utilized The Edinburgh Postnatal Depression Scale (EPDS) for outcome assessment ( n = 12), followed by The Beck Depression Inventory (BDI) ( n = 6), The Hamilton Rating Scale for Depression (HDRS) ( n = 2), The Patient Health Questionn aire (PHQ-9) ( n = 2), The Quick Inventory of Depressive Symptomatology (QIDS), and The Depression Anxiety Stress Scales (DASS-21) ( n = 2).…”

“…https://doi.org/10.1017/gmh.2023.8 Published online by Cambridge University Press Accepted Manuscript 2009;Ngai et al, 2015;Van Horne et al, 2021) and both periods (n=7)(McKee et al, 2006;O'Mahen et al, 2013a;Prendergast J, 2001;Rahman et al, 2018;Rahman et al, 2008;Sikander et al, 2019b;Tandon et al, 2018;Trevillion, 2014). Eleven interventions were delivered in communities, especially through home visits(Ammerman et al, 2013;Burns et al, 2013;Chabrol et al, 2002;Cooper et al, 2003;Morrell et al, 2009;Prendergast J, 2001;Rahman et al, 2008; Sikander et al, 2019a;Tandon et al, 2018;Van Horne et al, 2021), three in multiple settings(Dimidjian et al, 2017;McKee et al, 2006;Silverstein et al, 2011), while the rest were delivered in healthcare settings (clinic or hospital)(Cho et al, 2008;Dimidjian et al, 2016; Hayden et al, 2012;Hou et al, 2014;Kordi et al, 2018;Nejad et al, 2021;Ngai et al, 2015;O'Mahen et al, 2013a;Trevillion, 2014;Yazdanimehr et al, 2016). A higher proportion of studies utilized EPDS for outcome assessment (n=12), followed by BDI (n=6), HDRS (n=2), PHQ-9 (n=2), QIDS and DASS-21 (n=2).A total of 18 interventions were tested for PND treatment and underpinned by CBT (n=16).…”

“…A higher proportion of studies utilized EPDS for outcome assessment (n=12), followed by BDI (n=6), HDRS (n=2), PHQ-9 (n=2), QIDS and DASS-21 (n=2).A total of 18 interventions were tested for PND treatment and underpinned by CBT (n=16). Three trials tested PST(Kordi et al, 2018;Silverstein et al, 2011;Van Horne et al, 2021), mindfulnessbased stress reduction or cognitive therapy (n=3)(Dimidjian et al, 2016;Nejad et al, 2021;Yazdanimehr et al, 2016), and BA therapy (n=1)(Dimidjian et al, 2017). These interventions were delivered by either specialists (n= 14), non-specialists (n=8), or multidisciplinary teams (n=2).Delivery agents reported diverse disciplinary backgrounds and experience in the delivery of care.Non-specialists ranged from peers(Sikander et al, 2019a), health visitors(Morrell et al, 2009;Tandon et al, 2018), and allied health professionals such as lady health workers(Rahman et al, 2008), midwives(Ngai et al, 2015), early childhood nurses(Prendergast J, 2001), and social workers(Ammerman et al, 2013; Hayden et al, 2012;McKee et al, 2006;Van Horne et al, 2021) and graduate students in social work, public health, and medical sciences(Silverstein et al, 2011).…”

“…Three trials tested PST(Kordi et al, 2018;Silverstein et al, 2011;Van Horne et al, 2021), mindfulnessbased stress reduction or cognitive therapy (n=3)(Dimidjian et al, 2016;Nejad et al, 2021;Yazdanimehr et al, 2016), and BA therapy (n=1)(Dimidjian et al, 2017). These interventions were delivered by either specialists (n= 14), non-specialists (n=8), or multidisciplinary teams (n=2).Delivery agents reported diverse disciplinary backgrounds and experience in the delivery of care.Non-specialists ranged from peers(Sikander et al, 2019a), health visitors(Morrell et al, 2009;Tandon et al, 2018), and allied health professionals such as lady health workers(Rahman et al, 2008), midwives(Ngai et al, 2015), early childhood nurses(Prendergast J, 2001), and social workers(Ammerman et al, 2013; Hayden et al, 2012;McKee et al, 2006;Van Horne et al, 2021) and graduate students in social work, public health, and medical sciences(Silverstein et al, 2011). While delivery agents specializing in mental health included practising clinical psychologists, graduate students, recent graduates(Burns et al, 2013;Chabrol et al, 2002;Cho et al, 2008), counsellors, and well-being practitioners(Hou et al, 2014;Trevillion, 2014).…”

“…While delivery agents specializing in mental health included practising clinical psychologists, graduate students, recent graduates(Burns et al, 2013;Chabrol et al, 2002;Cho et al, 2008), counsellors, and well-being practitioners(Hou et al, 2014;Trevillion, 2014). Half of these interventions (n=12) were integrated into healthcare settings(Ammerman et al, 2013;Dimidjian et al, 2016;Dimidjian et al, 2017;Hou et al, 2014;Morrell et al, 2009;Ngai et al, 2015;Prendergast J, 2001;Rahman et al, 2008; Sikander et al, 2019a;Tandon et al, 2018;Trevillion, 2014;Van Horne et al, 2021).The number of sessions ranged from one for prevention intervention byChabrol et al (Chabrol et al, 2002) to sixteen for treatment (Thinking Healthy Programme) of PND(Rahman et al, 2008). Among non-specific interventions, most frequently utilized non-specific active ingredients were active listening (n=10), empathy (n=9), collaboration (n=9) and inciting social support (n=9) and normalization (n=7).…”