Preventing perinatal depression in community health settings

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Preventing perinatal depression in community
health settings

• Huynh-Nhu Le, Ph.D.
• George Washington University

DHHS/HRSA/Maternal and Child Health
Bureau/ Division of Research,Training and
Education R40 MC 02497
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Overview

• Prevention of perinatal depression
• The Mothers and Babies Mood and Health Project
• Intervention
• Preliminary findings
• Practice and policy implications

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Prevention (of new cases, i.e., before onset of
disorder)
Treatment (for individuals with disorder)
Maintenance (of normal mood after recovery)
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Postpartum Depression Prevention Trials

• No significant prevention effects
• Stamp, Williams, Crowther (1995)
• Brugha et al. (2000)
• Significant effects
• Elliott et al. (2000) groups for first-time
  mothers
• Zlotnick et al. (2001, 2006) interpersonal
  approach with low-income women

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One-year Incidence of Major Depressive Episodes
14.3 vs. 25
Muñoz et al., 2007
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The Mothers and Babies Mood and Health Project

• Goal Reduce the onset of major depressive
  episodes by teaching women mood regulation skills
  and education regarding parenting and child
  development.
• Focus on mothers-to-be, with the long-term aim of
  reducing depression risk in infants.

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Randomized Controlled Trial
MEDIATING VARIABLES
OUTCOME
Maternal Efficacy Maternal infant health
prenatal care
Usual Care
Depressive sx MDE incidence Maternal
efficacy Maternal infant health Mother-child
interaction
Positive thoughts Social support Pleasant
activities
Mothers Babies Course
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Community Partners
The Marys Center for Maternal and Child Care
The Center for Life at Providence Hospital
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The Mothers and Babies Course

• 8 sessions during pregnancy
• 3 booster sessions (6 weeks, 4 12 months PP)
• Cognitive Behavioral Theory
• Relevant perinatal topics
• Emphasis on a New Latino sample

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Measures

• Depression outcomes
• Center for Epidemiological Studies Depression
  Scale (CES-D Radloff, 1997) depressive sx
  screener.
• Beck Depression Inventory (BDI-II) depressive sx
  outcome.
• Mood Screener (Muñoz, 1998) 9 sx of DSM-IV-TR
  Major Depressive Episode criteria.

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Eligibility Criteria

• Demographics
• 18 and 35 years of age
• lt 24 weeks gestation
• No smoking, alcohol, substance use
• High risk for Depression
• History of Depression 110 (50.0)
• CES-D 16 49 (22.3)
• Dep Hx CES-D 16 61 (27.7)

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Figure 1 Recruitment
Contacts with potential participants by center
staff N 553


Contacts with potential participants by research
staff
N1,349
Center staff administered Screening
Interviews n 516
(68.3)
Research staff administered Screening
Interviews n 240
(31.7)
No dep hx n137 CESD lt16 n310 Demographic
n319 Current depression n39
Eligible n 310 (41.0)
Not eligible n 446 (59.0)
Not randomized n 90 (29.0)
Randomized n 220 (71.0)
Not interested/too busy n23 Past gestation
n14 Work conflict n15 Unable to contact
n26 Miscarriage n8 Other n4
Intervention N 112 (50.9)
Usual Care N 108 (49.1)
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Randomized Controlled Trial
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Demographics I (N 220)
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Demographics II
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Intervention AttendanceN 112
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Depressive Symptoms (BDI-II) N 63 completers
Pregnancy
Postpartum
Note All group differences N.S.
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Incidence of Major Depressive Episodes (MDEs)
from Baseline to One-year Postpartum
12.9
3.1
Note ns
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Summary

• Preliminary findings from first 63 completers
• No differences in the levels of depressive
  symptoms between groups
• Trend for a difference in MDEs between groups
• Feasible to screen and conduct a preventive group
  intervention with low-income, pregnant Latinas.

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Practice Policy Implications

• Need to integrate mental health prevention into
  perinatal care
• Include ongoing screening and follow-up of
  high-risk groups
• Prevention is important and worthwhile
• Decrease stigma
• Two-generational approach

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Prevention and Treatment of Perinatal Depression
Dep
TX
TX
Dep
Dep
Routine Screening of all prenatal care patients
Routine Screening of all postpartum care patients
Birth
Not Dep
Prevention
Dep
Not Dep
Not Dep
Not Dep
6 weeks
6 months post-TX or postpartum
Intervention Mothers Babies/Cognitive
Behavioral Theory
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Research Team

• Co-PI Deborah Perry (Johns Hopkins University)
• Coordinator Adriana Ortiz
• Research Staff
• Glorimar Ortiz - Carina Viera
• Laila Hochhausen - Katherine Ulrich
• Marta Genovez - Swati Singh
• Michelle Mackenzie - Julie Wallick
• Former staff
• H. Avillán, W. Bamatter, M.L. Berbery, M.
  Firmino Castillo, A. Chapman, S. Choi, L.
  Chowdhary, L. Cohen R. Craig, L. DiCesare, M.
  Hernandez, L. Jacob, L. Matherne, C. Reyes, J.
  Roman, K. Schaefer, A. Tsega, M. Janes, X. Sheng,
  C. Quiñonez, M. Vera

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Community Partners The Marys Center for
Maternal and Child Care The Center for Life at
Providence Hospital
DHHS/HRSA/MCHB/Division of Research, Training
and Education R40 MC 02497
www.gwu.edu/mbp hnle_at_gwu.edu