A PILOT RANDOMIZED CONTROLLED TRIAL OF COGNITIVE BEHAVIORAL THERAPY FOR PERINATAL DEPRESSION ADAPTED FOR WOMEN WITH LOW INCOMES
Article first published online: 14 JAN 2013
© 2013 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 30, Issue 7, pages 679–687, July 2013
How to Cite
O'Mahen, H., Himle, J. A., Fedock, G., Henshaw, E. and Flynn, H. (2013), A PILOT RANDOMIZED CONTROLLED TRIAL OF COGNITIVE BEHAVIORAL THERAPY FOR PERINATAL DEPRESSION ADAPTED FOR WOMEN WITH LOW INCOMES. Depress. Anxiety, 30: 679–687. doi: 10.1002/da.22050
- Issue published online: 1 JUL 2013
- Article first published online: 14 JAN 2013
- Manuscript Accepted: 8 DEC 2012
- Manuscript Revised: 29 NOV 2012
- Manuscript Received: 12 MAY 2012
- NIMH. Grant Number: 5R34MH076219
- CBT/cognitive behavior therapy;
- pregnancy and postpartum;
- primary care, behavioral activation, behavior therapy
Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression-specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low-income women with Major Depressive Disorder (MDD).
Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre-treatment, 16 week post-randomization, and 3-month follow-up.
Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good. In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at 16-week post-randomization and 3-month follow-up, Cohen's d = –0.71 (95% CI –4.93, –5.70).
Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low-incomes in prenatal care settings. Targeted delivery and content modifications are needed to engage populations tailored to setting and psychosocial challenges specific to the perinatal period.