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Randomized Controlled Trial
. 2023 Jun 1;80(6):539-547.
doi: 10.1001/jamapsychiatry.2023.0702.

Effect of Brief Interpersonal Therapy on Depression During Pregnancy: A Randomized Clinical Trial

Benjamin L Hankin  1 , Catherine H Demers  2   3 , Ella-Marie P Hennessey  2 , Sarah E D Perzow  2 , Mary C Curran  4 , Robert J Gallop  5 , M Camille Hoffman  3   6 , Elysia Poggi Davis  2   7
Affiliations
Randomized Controlled Trial

Effect of Brief Interpersonal Therapy on Depression During Pregnancy: A Randomized Clinical Trial

Benjamin L Hankin et al. JAMA Psychiatry. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Curran reported personal fees from the University of Denver during the conduct of the study. Dr Hoffman reported grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram
Participants allocated to interpersonal psychotherapy and designated as “did not receive intervention” did not attend any prenatal intervention sessions.
Figure 2.
Figure 2.. Effect of Intervention on Depression Symptom Trajectories Over Pregnancy
The color shaded regions represent 95% CIs. Hierarchical linear modeling (HLM) results with full sample for intent-to-treat analyses included 115 individuals in the interpersonal psychotherapy (IPT) group and 119 in the enhanced usual care (EUC) group. A, Depressive symptoms were measured by the 20-item Symptom Checklist (SCL-20) and showed significant intervention × time interaction (t229 = 4.31; P < .001; d = .57) with differential improvement for IPT relative to EUC on SCL-20 depression symptoms over time. SCL-20 scores can range up to 80. B, Depressive symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS). HLM showed significant intervention × time interaction (t229 = 2.73; P = .007; d = .40) with differential improvement for IPT relative to EUC on EPDS depression symptoms over time.
Figure 3.
Figure 3.. Effect of Intervention on Major Depressive Disorder (MDD) DSM-5 Diagnosis Rate
With full sample for intent-to-treat analyses (interpersonal psychotherapy [IPT]: n = 115; enhanced usual care [EUC]: n = 119), between-groups analysis showed significant difference (χ21 = 17.13; P < .001) for DSM-5 MDD rate posttreatment (end of gestation). Participants assigned to IPT showed greater MDD remittance relative to EUC (odds ratio, 4.99; 95% CI, 2.08-11.97).
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References

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