Depression Prevention in Pregnant AI Teens Using CBT

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DESCRIPTION (provided by applicant): This R34 proposal addresses the needs of one of the most vulnerable and under- served populations in the United States - pregnant, reservation-based American Indian (Al) teens. The primary aim is to determine the feasibility and preliminary effectiveness of a cognitive behavioral intervention delivered by Native paraprofessionals to reduce levels of depressive symptoms during pregnancy and the postpartum period. Teen pregnancy is common on Reservations, and AI teens report high levels of depressive symptoms and are at a high risk for the development of major depressive disorder (MDD) due to numerous psychosocial and environmental factors. Depression during pregnancy and postpartum is associated with significant impairments in functioning for both the mother and her offspring. The lack of mental health services on Reservations, especially for this vulnerable population, underscores the need for a low-cost early intervention aimed at reducing depressive symptoms. The first three months of the grant will be designated to finalize the intervention and assessment battery, complete training of AI paraprofessionals, and ensure initial feasibility and acceptability. Preliminary effectiveness of the intervention will be assessed using a 2 (interventions: Living in Harmony versus an Education-Support comparison) x 5 (assessment periods: pre and post-intervention and 4, 12 and 24 weeks postpartum) design. Masked independent evaluators (IE) will conduct assessments of outcomes. Intervention adherence and quality assurance will be assessed via structured manuals, audio-taped sessions reviewed by IEs, and ongoing weekly supervision. The study will be conducted by employees of the Center for American Indian Health at Johns Hopkins University, which has a 23-year history working on Indian Reservations. If findings from the present study are positive, the intervention will be evaluated in a larger study (R01).