Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: The design of the MOMCare study

Abstract

Background Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services(MSS). Methods Pregnant, public health patients, ≥18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9(PHQ-9) or the Mini-International Neuropsychiatric Interview(MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline(one-year postpartum). Baseline Results 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making ≤$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% an unplanned pregnancy. Conclusions A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study.

Postpartum depression and infant feeding practices in a low income urban settlement in Nairobi-Kenya

“…Given the high prevalence of depression among women of childbearing age, practitioners working with women in prenatal care settings should routinely screen for depression and provide targeted treatment and preventive services. Clinical trials of Interpersonal Therapy show promise for group-based treatment of adults delivered by community health workers in E. Africa, [40] and for treatment of pregnant women living in low income settings in the U.S. [41]. Currently, an IPT trial with women who are HIV+ and depressed is underway in western Kenya [42].…”

Collaborative Care for Perinatal Depression in Socioeconomically Disadvantaged Women: A Randomized Trial

“…16 MOMCare included novel design components, including a pre-therapy engagement session to help resolve practical, psychological, and cultural barriers to care; patient choice of brief interpersonal psychotherapy (brief IPT) and/or pharmacotherapy from her OB provider for acute treatment; telephone sessions in addition to in-person visits; 16 outreach for women missing sessions, including texting, telephone calls; and utilizing depression care specialists (DCSs) to deliver both the intervention and case management to meet basic needs (food, housing, job training, etc.). 16 …”

“…[4][5][6] Antenatal depression alone has been found to be predictive of developmental adversity in childhood and adolescence. [5,6] For example, findings from a prospective study showed that depression during pregnancy increases the risk for depression in 16 year old offspring by 4.7 times compared to unexposed offspring, even when their mothers recover from depression after birth. [6] Clearly, treating antenatal depression is critical in preventing deleterious consequences for women, children, and families.…”

Preterm Birth and Social Support during Pregnancy: a Systematic Review and Meta‐Analysis

“…The association between anxiety, stress, and depression during the prenatal period and PTB is well established . Two meta‐analyses examined these relationships and reported a pooled risk ratio of 1.39 (95% CI 1.19, 1.61) and 1.50 (95% CI 1.33, 1.70) for depression and maternal anxiety, respectively .…”