Pilot randomized controlled trial of interpersonal counseling for subsyndromal depression following miscarriage.
OBJECTIVE
Miscarriage, which occurs in 10% to 20% of clinically recognized pregnancies, is associated with an increased risk for subsyndromal depression. We examined whether Interpersonal Counseling (IPC) was superior to treatment as usual (TAU) in reducing subsyndromal depression among miscarrying women and, secondarily, superior to TAU in improving role functioning.


METHODS
Nineteen of 20 eligible women participated in a randomized controlled trial of 1 to 6 weekly telephone sessions of IPC versus TAU, which consisted of whatever lay counseling or professional care women sought on their own initiative, from October 2001 to April 2002. The 2 trial arms were compared on mean within-subject change in Hamilton Rating Scale for Depression-17-item (HAM-D-17) scores and in role functioning scale scores (a 5-item modification of the 36-item Medical Outcomes Study questionnaire) from baseline to post-intervention.


RESULTS
In the primary intent-to-treat analysis, the baseline mean HAM-D-17 scores were 18.0 (SD +/- 8.4) and 14.8 (SD +/- 6.6) in the IPC (N = 10) and TAU (N = 9) arms, respectively; post-intervention, the corresponding means were 11.6 (SD +/- 8.2) and 12.9 (SD +/- 8.3). The mean within-subject decline in HAM-D-17 scores was significantly greater in the IPC (6.4) than in the TAU (1.9) arm (difference in mean within-subject score decline, adjusted for design features, baseline HAM-D-17 scores and for baseline ethnic imbalance between study arms, 6.2 [95% CI = 0.4 to 12.0]). In a subordinate completers' analysis (N = 15), the corresponding mean decline and difference in adjusted mean decline were 8.0, 2.4, and 6.7 (95% CI = 0.4 to 13.1), respectively. Treatment was unrelated to improved role functioning.


CONCLUSIONS
The efficacy of telephone-administered IPC for subsyndromal depression after miscarriage warrants testing in a full-scale randomized controlled trial.
Neugebauer
Richard
R
Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, G H Sergievsky Center, Columbia University, New York, NY 10032, USA. RN3@columbia.edu
Kline
Jennie
J
Markowitz
John C
JC
Bleiberg
Kathryn L
KL
Baxi
Laxmi
L
Rosing
Mark A
MA
Levin
Bruce
B
Keith
Jessica
J
D000022:Abortion, Spontaneous / Q000523:psychology*; D000328:Adult; D003376:Counseling / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D010865:Pilot Projects; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods*; D019114:Remote Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome