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Slide 1 - 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
Slide 2 - Overview Prevention of perinatal depression The Mothers and Babies: Mood and Health Project Intervention Preliminary findings Practice and policy implications
Slide 3 - Prevention (of new cases, i.e., before onset of disorder) Treatment (for individuals with disorder) Maintenance (of normal mood after recovery)
Slide 4 - 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
Slide 5 - One-year Incidence of Major Depressive Episodes 14.3% vs. 25% Muñoz et al., 2007
Slide 6 - 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.
Slide 7 - Usual Care Positive thoughts Social support Pleasant activities prenatal care Depressive sx MDE incidence Maternal efficacy Maternal & infant health Mother-child interaction Maternal Efficacy Maternal & infant health MEDIATING VARIABLES OUTCOME Mothers & Babies Course Randomized Controlled Trial
Slide 8 - Community Partners The Mary’s Center for Maternal and Child Care The Center for Life at Providence Hospital
Slide 9 - 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
Slide 10 - 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.
Slide 11 - 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%)
Slide 12 - 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 randomized n = 90 (29.0%) Not interested/too busy n=23 Past gestation n=14 Work conflict n=15 Unable to contact n=26 Miscarriage n=8 Other n=4 Research staff administered Screening Interviews n = 240 (31.7%) No dep hx n=137 CESD <16 n=310 Demographic n=319 Current 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
Slide 13 - Randomized Controlled Trial
Slide 14 - Demographics I (N = 220)
Slide 15 - Demographics II
Slide 16 - Intervention Attendance N = 112
Slide 17 - Pregnancy Depressive Symptoms (BDI-II) N = 63 completers Postpartum Note: All group differences N.S.
Slide 18 - Incidence of Major Depressive Episodes (MDEs) from Baseline to One-year Postpartum 3.1% 12.9% Note: ns
Slide 19 - 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.
Slide 20 - 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
Slide 21 - Routine Screening of all prenatal care patients 6 weeks 6 months post-TX or postpartum Prevention and Treatment of Perinatal Depression Prevention Dep Not Dep TX Birth Routine Screening of all postpartum care patients Intervention: Mothers & Babies/Cognitive Behavioral Theory Dep Not Dep TX Dep Not Dep Dep Not Dep
Slide 22 - 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
Slide 23 - www.gwu.edu/~mbp hnle@gwu.edu DHHS/HRSA/MCHB/Division of Research, Training and Education R40 MC 02497 Community Partners: The Mary’s Center for Maternal and Child Care The Center for Life at Providence Hospital
 

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