Development of a Home-Based Family Treatment for Postpartum Depression

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DESCRIPTION (provided by applicant): Although 10-15% of women experience postpartum depression (PPD) after giving birth to a child, the majority do not receive any form of mental health treatment. As highlighted in NIMH PA-06-376 "Women's Mental Health in Pregnancy and the Postpartum Period," developing a wider range of treatment options for women with PPD is critically important given the serious repercussions associated with the disorder for both the mother and the developing infant. Very few empirically-supported treatments exist for women with PPD, and the depression treatments most widely available in the community involve psychopharmacology, an approach viewed to be unacceptable by many postpartum women, particularly those who are breastfeeding. Family-based interventions are particularly well-suited to treat PPD, in that postpartum depression occurs during a period of significant family transition; moreover, research has shown that poor family functioning and low levels of partner support predict the onset and course of the disorder. Given the serious repercussions of PPD, the lack of existing treatments, and the critical role of the family in the disorder, we propose to develop and evaluate a novel family-based treatment, Family Treatment for Postpartum Depression (FTP) which will target specific areas of family dysfunction associated with PPD. The PI has already completed an open pilot trial of an initial, clinic-based version of FTP, finding that it was acceptable to patients, feasible to administer, and possibly efficacious. In this application, we propose to expand the intervention and evaluate it in a pilot randomized controlled trial, comparing it to a supportive individual therapy condition. In recognition of the many barriers that can contribute to low utilization rates of postpartum women, particularly those who are breastfeeding, treatment will be optionally provided in the home, for patients who find this more convenient, rather than requiring women to travel to a clinic setting for care. In addition, strategies will be taken to broaden the generalizability of the treatment to a wider range of patient groups. Following an initial period of treatment refinement, we propose to conduct a pilot randomized controlled pilot trial to evaluate the feasibility, acceptability and preliminary efficacy of the intervention, comparing the family treatment to supportive psychotherapy. In addition, we will develop and evaluate a therapist-training program. Findings from the small RCT will be used to provide the basis for an R01 grant application to support a full-scale randomized treatment outcome study. Postpartum depression (PPD) is associated with numerous adverse consequences for mothers and their developing infants; however, the majority of women with PPD do not receive any treatment. This study will focus on developing a novel, home-based family treatment for PPD and will evaluate this intervention in a pilot randomized controlled trial. This approach is intended to provide a more acceptable and accessible type of treatment for postpartum women who may otherwise not seek traditional, clinic-based mental health care.