title: Potential impact of trauma on the ability to prevent depression among low-income mothers.
abstract: BACKGROUND
  Violent trauma is common in urban communities. We explored the hypothesis that past trauma could moderate the effect of a cognitive behavioral intervention designed to prevent depression among urban, low-income mothers.
  
  
  METHODS
  Synthesis of two pilot randomized trials of problem solving education (PSE) among 93 mothers of children hospitalized in the neonatal intensive care unit or enrolled in community-based Early Intervention programs. Outcomes included depressive symptoms, perceived stress, and social functioning. Results were adjusted for baseline depressive symptoms, then stratified according to subjects' trauma history.
  
  
  RESULTS
  Fifteen of the 44 PSE subjects (34%) experienced a moderately severe depressive symptom episode during the 3-month follow-up period, as opposed to 21 of 45 control subjects (47%), for a nearly significant adjusted odds ratio (aOR) of 0.36 (95% CI: 0.13, 1.02). Among mothers without trauma histories, far fewer PSE mothers (5 of 24; 21%) experienced an episode of moderately severe depressive symptoms than control mothers (12 of 26; 46%) for a significant aOR of 0.15 (95% CI: 0.03, 0.79). Conversely, among mothers with trauma histories, a similar proportion of PSE mothers (10 of 19; 53%) experienced an episode of moderately severe depressive symptoms as control mothers (9 of 19; 47%). Similar trends held for perceived stress and social functioning.
  
  
  CONCLUSIONS
  PSE may be more effective at preventing depression among mothers without trauma histories. Our results are consistent with the depression treatment literature, but are novel because they support the principle of intervention moderation in risk prevention, as opposed to treatment, paradigm.
authors.affiliation: Boston Medical Center, Boston, Massachusetts 02118, USA. michael. silverstein@bmc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.forename: Emily
authors.initials: E
authors.lastname: Feinberg
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Yaminette Diaz
authors.initials: YD
authors.lastname: Linhart
authors.forename: Jenna
authors.initials: J
authors.lastname: Sandler
authors.forename: Mark
authors.initials: M
authors.lastname: Hegel
authors.forename: Danielle Pierce
authors.initials: DP
authors.lastname: Appugliese
authors.forename: William
authors.initials: W
authors.lastname: Beardslee
mesh_terms: D000328:Adult; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019052:Depression, Postpartum / Q000517:prevention & control* / Q000523:psychology*; D003866:Depressive Disorder / Q000517:prevention & control* / Q000523:psychology; D002658:Developmental Disabilities / Q000523:psychology*; D018479:Early Intervention, Educational; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008016:Life Change Events; D009035:Mothers / Q000523:psychology*; D010865:Pilot Projects; D011203:Poverty; D011340:Problem Solving; D016896:Treatment Outcome; D014505:Urban Population