Enhancing Interpersonal Psychotherapy for Mothers and Expectant Mothers on Low Incomes: Adaptations and Additions

Abstract

Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.

Cluster Randomized Controlled Trial of Intervention to Increase Participant Retention and Completed Home Visits in the Nurse-Family Partnership

“…A central goal of the RI was to reinforce with nurses the self-efficacy and strength-based clinical underpinnings of the program, particularly, that NFP participants are the experts in their own lives and that they know the frequency of visits and duration of participation that will work best for them. The results from this trial, as well as the preceding pilot study, align with other studies demonstrating the positive impact of motivational strategies to engage families in mental health treatment (e.g., Grote et al 2008). They also align with recently published findings from the Memphis trial of the NFP that examined latent class trajectories of home visits completed from pregnancy through child aged 2, in which there was a group of lower risk participants that managed to improve their own health and the health of their children with far fewer visits completed after birth than is included in the standard visitation schedule (Holland et al 2014).…”

Quasi-Experimental Pilot Study of Intervention to Increase Participant Retention and Completed Home Visits in the Nurse–Family Partnership

“…The approach grew out of the ideas and successful strategies employed by NFP nurse home visitors, and from analyses of data from NFP participants and sites. It shares some components included in other successful engagement interventions tested with families seeking mental health treatment, however, such as addressing both practical and psychological barriers to participation (Grote, Swartz, & Zuckoff, 2008; Nock & Kazdin, 2005; Szapocznik, et al, 1988; Ingoldsby, 2010). …”

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

“…38,63,64 Brief IPT consists of 8 individual sessions provided over 8 or more weeks. It retains the core features of standard IPT, 65 such as strengthening social supports, building on patient strengths and coping strategies, and resolving interpersonal problems. At the same time, brief IPT offers several advantages over standard IPT.…”

“…65,69 Pragmatic enhancements to brief IPT relevant to the culture of poverty 70 included integrating a case management component into brief IPT and using the telephone to conduct acute brief IPT, a practice found to be effective in the delivery of psychotherapy and pharmacotherapy for depression. 71 The DCS also engaged in intensive outreach to retain their patients in treatment, with telephone calls, texting, email, showing up at the patient's non-stigmatizing public health setting, meeting in coffee shops, or at the patient's home.…”