Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention

Abstract

Background: Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown.

Purpose: We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions.

Methods: Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum.

Results: End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect.

Conclusion: Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components.

Clinical trial registration: NCT00757068.

Keywords: Depressive symptoms; Postpartum; Relapse prevention; Smoking cessation.

Fig. 1.

End-of-pregnancy depressive symptoms moderate response to treatment. STARTS, Strategies to Avoid Returning to Smoking (intervention with added focus on mood, stress, and weight concerns); SUPPORT, supportive, time and attention-controlled comparison; depressed, women who endorsed clinically significant end-of-pregnancy depressive symptoms on the Edinburgh Postnatal Depression Scale (scores ≥13); nondepressed, women who endorsed clinically significant end-of-pregnancy depressive symptoms on the Edinburgh Postnatal Depression Scale (scores ≤12).