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 EducationR40 MC 02497

Overview

Prevention of perinatal depression The Mothers and Babies: Mood and

Health ProjectInterventionPreliminary findings

Practice and policy implications

Prevention(of new cases, i.e., before onset

of disorder)

Treatment(for individuals with disorder)

Maintenance (of normal mood after

recovery)

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

One-year Incidence of Major Depressive Episodes

0

5

10

15

20

25

30

MB Course

Control

14.3% vs. 25%Muñoz et al., 2007

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.

Usual Care

Positive thoughts Social support Pleasant activities

prenatal care

Depressive sxMDE incidence

Maternal efficacyMaternal & infant healthMother-child interaction

Maternal EfficacyMaternal & infant health

MEDIATING VARIABLES OUTCOME

Mothers & Babies Course

Randomized Controlled Trial

Community Partners

The Mary’s Center for Maternal and Child Care

The Center for Life at Providence Hospital

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

Eligibility Criteria

Demographics: 18 and 35 years of age < 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%)

Center staff administered Screening Interviews

n = 516 (68.3%)

Not eligible n = 446

(59.0%)

Eligible n = 310

(41.0%)

Randomized n = 220

(71.0%)

Intervention N = 112 (50.9%)

Usual Care N = 108 (49.1%)

Not randomizedn = 90 (29.0%)

Not interested/too busy n=23Past gestation n=14Work conflict n=15Unable to contact n=26Miscarriage n=8Other n=4

Research staff administered Screening Interviews n = 240 (31.7%)

No dep hx n=137CESD <16 n=310Demographic n=319Current depression n=39

Figure 1: Recruitment

Contacts with potential participants by center staff N = 553

Contacts with potential participants by research staff N=1,349

M (SD)

Age 25.4 (4.6)

Education (years) 8.9 (4.0)

Marital Status Married/Cohabitating Single Separated Widowed

63.5%30.0% 6.0% 0.5%

First Pregnancy 40.9%

Weeks gestation 17.6 (6.6)

Demographics I (N = 220)

Birthplace El Salvador

Mexico

Honduras

Guatemala

Other

54.5%

15.5%

10.9%

10.0%

1.4%

7.7%

Years in U.S. M (SD) 4.3 (4.7)

At least 1 child living in home country

30.9%

Demographics II

Intervention AttendanceN = 112

Class attendance 0 classes attended: 12.5%

Classes attended: M = 5.2 SD = 3.2 (1-8)

Pregnancy

Depressive Symptoms (BDI-II)N = 63 completers

15.6

12.1

5.0

7.58.2

4.6

6.3

8.4

11.9

15.2

0

2

4

6

8

10

12

14

16

18

T1 T2 T3 T4 T5

Intervention(N=32)

Usual Care (N=31)

PostpartumNote: All group differences N.S.

Incidence of Major Depressive Episodes (MDEs) from Baseline to One-year Postpartum

0

2

4

6

8

10

Intervention

Usual Care

3.1%

12.9%

Note: ns

Summary

Preliminary findings from first 63 completers: No differences in the levels of depressive

symptoms between groupsTrend for a difference in MDEs between

groups Feasible to screen and conduct a

preventive group intervention with low-income, pregnant Latinas.

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

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

www.gwu.edu/~mbphnle@gwu.edu

DHHS/HRSA/MCHB/Division of Research, Training and EducationR40 MC 02497

Community Partners:

The Mary’s Center for Maternal and Child Care

The Center for Life at Providence Hospital