title: A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Mood Disorder Centre, University of Exeter, Exter EX4 4QG, UK. Ho215@ex.ac.uk
authors: Heather
authors: H
authors: O'Mahen
authors: Joseph A
authors: JA
authors: Himle
authors: Gina
authors: G
authors: Fedock
authors: Erin
authors: E
authors: Henshaw
authors: Heather
authors: H
authors: Flynn
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000628:therapy*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance; D017060:Patient Satisfaction; D010865:Pilot Projects; D011203:Poverty / Q000523:psychology*; D011247:Pregnancy / Q000523:psychology*; D011248:Pregnancy Complications / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
keywords: CBT/cognitive behavior therapy; depression; maternal-child; pregnancy and postpartum; primary care, behavioral activation, behavior therapy; treatment