The 10-13% prevalence of Antepartum Depression (APD) increases 2 fold in women with poor social supports, low socioeconomic status (SES) and negative life events. APD causes low birth weight, prematurity and eclampsia. APD is one of the best predictors of postpartum depression (PPD), which in turn causes impaired infant and childhood emotional and cognitive development. Therefore, treating APD is a method of primary and secondary prevention by treating parents of children at risk. Yet, there are no treatment guidelines for antepartum depression. This application is based on findings from a previous bilingual controlled clinical trial of Interpersonal Psychotherapy adapted for APD (IPT-P). The mood of the IPT-P treatment group significantly improved on all mood scores compared to a matched Parenting Education Program (PEP) control with the same duration, frequency and intensity of contact as the treatment group. This study sample was comprised of a majority of indigent Spanish speaking immigrant women with multiple psychosocial and financial stressors. Because of the small sample size, there was no information on the relationship of demographic variables such as race and SES to treatment feasibility, prognosis and attachment. Data from the National Comorbidity Study illustrated that effects of ethnicity and race must be examined in the context of SES and psychosocial variables in order to determine disparities in care and treatment outcome. In the proposed trial, a larger more diverse sample (N=150) of women from 3 different sites in New York City will provide enough power to generalize findings and determine the relationship of subgroup variables such as race/ethnicity and SES to treatment feasibility, motherhood and attachment. 3 sites (New York State Psychiatric Institute/New York Presbyterian Hospital at Columbia, New York Presbyterian Hospital at Cornell and St. Luke's Roosevelt hospital) will provide equal proportions of Latina, African American and White depressed pregnant women. Each subject will be randomized to 12 weeks of IPT-P or PEP, then followed for 6 months postpartum to determine if the IPT-P is more effective in reducing depression, preventing PPD and improving maternal infant attachment. Co-investigators are maternal fetal medicine faculty from respective sites who will be primary liaison to the respective departments of obstetrics and provide clinical obstetrical needs of the study.
| Spinelli, Margaret G; Endicott, Jean; Goetz, Raymond R (2013) Increased breastfeeding rates in black women after a treatment intervention. Breastfeed Med 8:479-84 |
