Depression Prevention for Poor Pregnant Women

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DESCRIPTION (provided by applicant): Postpartum depression (PPD) is a significant public health problem occurring in 10-16% of recently delivered mothers. With approximately 4,000,000 women giving birth annually in the United States, there is an enormous amount of morbidity associated with PPD - at least 400,000 postpartum women will be depressed each year. PPD exacts a substantial toll on women which extends to the family as well; infants of depressed mothers are at risk for disturbances in infant development and later child adjustment. Further, only a limited number of studies have tested the efficacy of treatments for PPD. Clearly, interventions that reduce the deleterious outcomes associated with PPD are of importance and will be of special interest to health care providers and policy makers, especially those interventions that have the potential to enhance community care. To date, there are few studies that have examined the effects of a preventive intervention to reduce PPD in high-risk women and research in this area has been limited by methodological problems. An area of even greater neglect is the testing of such an intervention for financially disadvantaged women. To reduce the risk of PPD in poor women is consequential as poor women represent a group of women at high-risk for PPD, the infants of poor women with PPD have an elevated risk for early infant interactional disturbances, and poor women are less likely to access treatment for depression than middle-class women. We propose to conduct a randomized trial in 240 pregnant women on public assistance at risk for PPD. The aim of this proposed project is to compare the efficacy of an intervention (the Postpartum Prevention Program; PPP) based primarily on interpersonal therapy to an enhanced care-as-usual control (ECU) condition. The PPP targets those factors that may play a significant role in the development of PPD (i.e., poor social support, role transitions, and life stressors) and is administered during the last trimester of pregnancy and within 2-weeks postpartum. Our main hypothesis is that the PPP will be significantly more efficacious than the ECU condition in reducing the risk of PPD over the course of one-year postpartum. Other hypotheses include that the PPP will be more efficacious than the ECU condition in reducing depressive symptoms, and utilization of mental health services as well as enhance maternal sensitivity and infant attachment.