Performance of a Culturally Tailored Cognitive-Behavioral Intervention Integrated in a Public Health Setting to Reduce Risk of Antepartum Depression: A Randomized Controlled Trial.
BACKGROUND
Cognitive-behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6-week, culturally tailored, cognitive-behavioral intervention offered to rural, minority, low-income women at risk for antepartum depression.


METHODS
A total of 146 pregnant women were stratified by high risk for antepartum depression (Edinburgh Postnatal Depression Scale [EPDS] score of 10 or higher) or by low-moderate risk (EPDS score of 4-9) and randomized to a cognitive-behavioral intervention or treatment as usual. Differences in mean change of EPDS and Beck Depression Inventory (BDI)-II scores for low-moderate and high-risk women in the cognitive-behavioral intervention and treatment as usual for the full sample were assessed from baseline (T1), posttreatment (T2), and one-month follow-up (T3), and for African American women in the subsample.


RESULTS
Both the cognitive-behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high risk for depression (n = 62), there was no significant treatment effect from T1 to T2 or T3 for the EPDS. However, in low-moderate risk women, there was a significantly greater mean change in the BDI-II scores from significant decrease in the BDI-II scores from T1 to T2 (4.92 vs 0.59, P = .018) and T1 to T3 (5.67 vs 1.51, P = .04). Also, the cognitive-behavioral intervention significantly reduced EPDS scores for African American women at high risk (n = 43) from T1 to T2 (5.59 vs 2.18, P = .02) and from T1 to T3 (6.32 vs 3.14, P = .04).


CONCLUSIONS
A cognitive-behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment as usual, the cognitive-behavioral intervention reduced depressive symptoms for African American women at high risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression. These promising findings need to be replicated in a larger controlled clinical trial that incorporates methods to maintain greater participant engagement.
D Elizabeth
DE
Jesse
Bradley N
BN
Gaynes
Elizabeth B
EB
Feldhousen
Edward R
ER
Newton
Shelia
S
Bunch
Steven D
SD
Hollon
D000328:Adult; D001741:Black or African American; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003152:Community Health Nursing; D054521:Cultural Competency; D003863:Depression / Q000517:prevention & control*; D019052:Depression, Postpartum / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008603:Mental Health; D008913:Minority Groups; D049590:Postpartum Period; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011634:Public Health; D012306:Risk; D012424:Rural Population; D055815:Young Adult
antepartum depression; antepartum depressive symptoms; cognitive-behavioral intervention; health disparities; pregnancy; randomized controlled trial