A Dyadic Approach to Perinatal Depression Treatment in Primary Care

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Project Summary Ten to 20% of women have depression in the perinatal period (pregnancy through one year postpartum), especially low income racial /ethnic minority women, yet many do not receive appropriate mental health treatment. Low parenting self-efficacy and impaired mother - infant interactions contribute to health-related burden and negative maternal and child outcomes. Yet these parenting issues are not addressed in current primary care-based perinatal depression treatments. Our team has developed, with user centered design techniques, a brief version of the evidence based Promoting First Relationships (PFR) parenting intervention: PFR-B. We now propose to test a comprehensive perinatal depression treatment - Maternal Infant and Dyadic Care (MInD) - that includes PFR-Brief in perinatal collaborative care, an evidence based intervention for perinatal depression. MInD will be responsive to the needs of women in primary care settings where most underserved women obtain prenatal care. By focusing on important mediators of worsened postpartum depression (decreased parenting self-efficacy and impaired mother-infant interaction), MInD has the potential to improve maternal outcomes, and in the long run, child outcomes. Our project specific aims are: Aim 1 To compare MInD vs. usual CC in a RCT to assess depression outcomes. Sixty women with depression in pregnancy will be randomly assigned to MInD or usual CC. We hypothesize that patients randomized to MInD will experience significantly better improvement in depression (measured by the Edinburgh Postpartum Depression Scale) at 3 months and 6 months postpartum compared to usual CC and that patients randomized to MInD will have significantly better functioning as measured by Sheehan Disability Scale and Barkin Index of Maternal Functioning compared to patients receiving usual CC. Aim 2: To explore the association between parenting self-efficacy, dyadic interaction and depression to inform a mediational hypothesis. We hypothesize that parenting self-efficacy will be greater and dyadic interaction will be improved in women randomized to MInD post treatment and will mediate differences in depression outcomes between patients randomized to MInD and usual CC. Aim 3: To examine relative utilization of MInD vs usual CC, feasibility of conducting the trial, assessment burden and perceived match of treatment to patient need. We will use a mixed methods strategy using the Working Alliance Inventory and in-depth patient interviews to compare MInD and usual CC. We hypothesize that patients randomized to MInD will have higher utilization of treatment as measured by attendance at least 3 antenatal and 3 postpartum CM sessions. We will explore the research question: How do the treatment experiences of patients randomized to MInD compare with the treatment experiences of patients randomized to usual CC? At the end of this project our multidisciplinary and complementary team will be poised to conduct an R01 funded, larger Hybrid Type I effectiveness-implementation RCT to study the effectiveness of MInD and prepare for implementation.