Perinatal loss includes early (before 20 weeks;miscarriage) and late fetal death (after 20 weeks;stillbirth) and the death of a liveborn neonate in the first 28 days after birth (neonatal death. Despite medical advances, spontaneous miscarriages occur in 10-15% of recognized pregnancies, with stillbirth occurring in 1 in 160 live births and neonatal death occurring in an additional 1 in 145 live births. Overall, about 650,000 women in the United States experience perinatal loss each year;of these, 11-13% (71,500 - 84,500) will experience a related major depressive episode. The rates of major depressive disorder (MDD) among women who have recently experienced perinatal loss are 3 times the rates of MDD among matched samples of community women. An elevated prevalence of MDD relative to other women of childbearing age is notable given that MDD already is twice as common in women as men, with peak onset during the childbearing years. Women who meet criteria for MDD following perinatal loss are at risk for severe and enduring morbidity and impairment, which can persist up to 30 months after the loss. Moreover, they have increased rates of both completed suicides and hospitalization for suicide attempts. In addition, regardless of the circumstances surrounding its onset, MDD is the leading cause of lost years of healthy life among women worldwide and the leading cause of non-obstetric hospitalization in young women in the United States. Despite recognition that MDD following perinatal loss is an important public health concern, that it causes significant impairment, and that treatment as usual has been inadequate, virtually no treatments have been developed for or tested in this population. Group Interpersonal Psychotherapy (IPT-G) has been shown to be efficacious in treating MDD in other populations and may be especially pertinent to the treatment needs of women experiencing MDD following perinatal loss because many of these needs are social and interpersonal in nature. The purposes of this application are to (a) adapt group interpersonal psychotherapy (IPT-G) to address the unique needs of women with MDD that occurs following perinatal loss, and (b) to collect preliminary data on its feasibility, acceptability, and initial efficacy relative to a dose-matched standard depression treatment (the Coping with Depression course) in a sample of 60 women to lay the groundwork for a larger clinical trial. Primary outcomes are treatment acceptability, time to remission from MDD, and reduced depressive symptoms. Secondary outcomes are social support and social functioning, couple distress, and grief. From a longer term perspective, this program of research will result in the adaptation of a specialized, efficacious treatment for a vulnerable and understudied population whose distress has historically been minimized.
Overall, about 650,000 women in the United States experience perinatal loss (including miscarriage, stillbirth, and early neonatal death) each year;of these, 11-13% (71,500 - 84,500) will experience a related major depressive episode. Women who meet criteria for major depressive disorder following perinatal loss are at risk for severe and enduring morbidity and impairment, which can persist up to 30 months after the loss, yet virtually no treatments have been developed or tested for this population. This project will adapt and test an interpersonally-based treatment to address the specific needs of this vulnerable and understudied population.
|Johnson, Jennifer E (2014) Integrating psychotherapy research with public health and public policy goals for incarcerated women and other vulnerable populations. Psychother Res 24:229-39|