IMPORTANCE: Prenatal depression is prevalent with negative consequences for both the mother and developing fetus. Brief, effective, and safe interventions to reduce depression during pregnancy are needed.
OBJECTIVE: To evaluate depression improvement (symptoms and diagnosis) among pregnant individuals from diverse backgrounds randomized to brief interpersonal psychotherapy (IPT) vs enhanced usual care (EUC).
DESIGN, SETTING, AND PARTICIPANTS: A prospective, evaluator-blinded, randomized clinical trial, the Care Project, was conducted among adult pregnant individuals who reported elevated symptoms during routine obstetric care depression screening in general practice in obstetrics and gynecology (OB/GYN) clinics. Participants were recruited between July 2017 and August 2021. Repeated measures follow-up occurred across pregnancy from baseline (mean [SD], 16.7 [4.2] gestational weeks) through term. Pregnant participants were randomized to IPT or EUC and included in intent-to-treat analyses.
INTERVENTIONS: Treatment comprised an engagement session and 8 active sessions of brief IPT (MOMCare) during pregnancy. EUC included engagement and maternity support services.
MAIN OUTCOMES AND MEASURES: Two depression symptom scales, the 20-item Symptom Checklist and the Edinburgh Postnatal Depression Scale, were assessed at baseline and repeatedly across pregnancy. Structured Clinical Interview for DSM-5 ascertained major depressive disorder (MDD) at baseline and the end of gestation.
RESULTS: Of 234 participants, 115 were allocated to IPT (mean [SD] age, 29.7 [5.9] years; 57 [49.6%] enrolled in Medicaid; 42 [36.5%] had current MDD; 106 [92.2%] received intervention) and 119 to EUC (mean [SD] age, 30.1 [5.9] years; 62 [52.1%] enrolled in Medicaid; 44 [37%] had MDD). The 20-item Symptom Checklist scores improved from baseline over gestation for IPT but not EUC (d = 0.57; 95% CI, 0.22-0.91; mean [SD] change for IPT vs EUC: 26.7 [1.14] to 13.6 [1.40] vs 27.1 [1.12] to 23.5 [1.34]). IPT participants more rapidly improved on Edinburgh Postnatal Depression Scale compared with EUC (d = 0.40; 95% CI, 0.06-0.74; mean [SD] change for IPT vs EUC: 11.4 [0.38] to 5.4 [0.57] vs 11.5 [0.37] to 7.6 [0.55]). MDD rate by end of gestation had decreased significantly for IPT participants (7 [6.1%]) vs EUC (31 [26.1%]) (odds ratio, 4.99; 95% CI, 2.08-11.97).
CONCLUSIONS AND RELEVANCE: In this study, brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics. As a safe, effective intervention to relieve depression during pregnancy, brief IPT may positively affect mothers' mental health and the developing fetus.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03011801.
| Discipline Area | Score |
|---|---|
| Obstetrics |  |
| FM/GP/Obstetrics |  |
| FM/GP/Mental Health | |
| Psychiatry | |
The results show that psychotherapy for maternal depression is effective for improving depression symptoms and Edinburgh scores. In my opinion, calling this "brief interpersonal therapy" is a bit misleading. The intervention group received eight 50-minute sessions. In other words, it's not really brief, it's just psychotherapy. The "enhanced usual care" group had several support services that many OB practices would find hard to implement. A huge barrier in treatment of depression is a lack of skilled providers who are willing to manage pregnant persons. If therapists must provide 400 minutes of care to impact outcome, it will stretch our resources even further. Surely, there's a better way?
Very useful trial. Needs replication.
Possible performance bias in that the intervention group received 8 individual sessions of 50" each and the controls had usual care + 1 individual session of 60".
The study brings important information to the field, but there are still crucial limitations to consider: single blinded study with subjective outcomes and lack of clarity concerning the primary endpoint.
