1. Preventing perinatal depression in community health settings Huynh-Nhu Le, Ph.D. George Washington University DHHS/HRSA/Maternal and Child Health Bureau/ Division of Research,Training and Education R40 MC 02497

2. Overview Prevention of perinatal depression The Mothers and Babies: Mood and Health Project Intervention Preliminary findings Practice and policy implications

3. Prevention (of new cases, i.e., before onset of disorder) Treatment (for individuals with disorder) Maintenance (of normal mood after recovery)

4. Postpartum Depression Prevention Trials No significant prevention effects: Stamp, Williams, & Crowther (1995) Brugha et al. (2000) Significant effects: Elliott et al. (2000): groups for first-time mothers Zlotnick et al. (2001, 2006): interpersonal approach with low-income women

5. One-year Incidence of Major Depressive Episodes 14.3% vs. 25% Muñoz et al., 2007

6. The Mothers and Babies: Mood and Health Project Goal: Reduce the onset of major depressive episodes by teaching women mood regulation skills and education regarding parenting and child development. Focus on mothers-to-be, with the long-term aim of reducing depression risk in infants.

7. Usual Care Positive thoughts Social support Pleasant activities prenatal care Depressive sx MDE incidence Maternal efficacy Maternal & infant health Mother-child interaction Maternal Efficacy Maternal & infant health MEDIATING VARIABLES OUTCOME Mothers & Babies Course Randomized Controlled Trial

8. Community Partners The Mary’s Center for Maternal and Child Care The Center for Life at Providence Hospital

9. The Mothers and Babies Course 8 sessions during pregnancy 3 booster sessions (6 weeks, 4 & 12 months PP) Cognitive Behavioral Theory Relevant perinatal topics Emphasis on a New Latino sample

10. Measures Depression outcomes Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1997): depressive sx screener. Beck Depression Inventory (BDI-II): depressive sx outcome. Mood Screener (Muñoz, 1998): 9 sx of DSM- IV-TR Major Depressive Episode criteria.

11. Eligibility Criteria Demographics:  18 and 35 years of age  < 24 weeks gestation  No smoking, alcohol, substance use High risk for Depression:  History of Depression110 (50.0%)  CES-D ≥ 16 49 (22.3%)  Dep Hx & CES-D ≥ 16 61 (27.7%)

12. Center staff administered Screening Interviews n = 516 (68.3%) Not eligible n = 446 (59.0%) Eligible n = 310 (41.0%) Randomized n = 220 (71.0%) Intervention N = 112 (50.9%) Usual Care N = 108 (49.1%) Not randomized n = 90 (29.0%) Not interested/too busy n=23 Past gestation n=14 Work conflict n=15 Unable to contact n=26 Miscarriage n=8 Other n=4 Research staff administered Screening Interviews n = 240 (31.7%) No dep hx n=137 CESD <16 n=310 Demographic n=319 Current depression n=39 Figure 1: Recruitment Contacts with potential participants by center staff N = 553 Contacts with potential participants by research staff N=1,349

13. Randomized Controlled Trial PregnancyPostpartum T0 T1T2T3T4T5 ScreeningPre-IntPost-Int6 wks4 mos.12 mos. M-I Interaction 756220188 (15D) 182 (2) 173 (3) 63 (1) MB CourseBoosters

14. M (SD) Age25.4 (4.6) Education (years)8.9 (4.0) Marital Status Married/Cohabitating Single Separated Widowed 63.5% 30.0% 6.0% 0.5% First Pregnancy40.9% Weeks gestation 17.6 (6.6) Demographics I (N = 220)

15. Birthplace El Salvador Mexico Honduras Guatemala Other 54.5% 15.5% 10.9% 10.0% 1.4% 7.7% Years in U.S. M (SD) 4.3 (4.7) At least 1 child living in home country 30.9% Demographics II

16. Intervention Attendance N = 112 Class attendance0 classes attended: 12.5% Classes attended: M = 5.2 SD = 3.2 (1-8)

17. Pregnancy Depressive Symptoms (BDI-II) N = 63 completers Postpartum Note: All group differences N.S.

18. Incidence of Major Depressive Episodes (MDEs) from Baseline to One-year Postpartum 3.1% 12.9% Note: ns

19. Summary Preliminary findings from first 63 completers: No differences in the levels of depressive symptoms between groups Trend for a difference in MDEs between groups Feasible to screen and conduct a preventive group intervention with low- income, pregnant Latinas.

20. Practice & Policy Implications Need to integrate mental health prevention into perinatal care Include ongoing screening and follow-up of high-risk groups Prevention is important and worthwhile Decrease stigma Two-generational approach

21. Routine Screening of all prenatal care patients 6 weeks 6 months post-TX or postpartum Prevention and Treatment of Perinatal Depression Prevention Dep Not Dep TX Birth Routine Screening of all postpartu m care patients Intervention: Mothers & Babies/Cognitive Behavioral Theory Dep Not Dep TX Dep Not Dep Dep Not Dep

22. Research Team Co-PI: Deborah Perry (Johns Hopkins University) Coordinator: Adriana Ortiz Research Staff: - Glorimar Ortiz- Carina Viera - Laila Hochhausen - Katherine Ulrich - Marta Genovez - Swati Singh - Michelle Mackenzie- Julie Wallick - Former staff: H. Avillán, W. Bamatter, M.L. Berbery, M. Firmino Castillo, A. Chapman, S. Choi, L. Chowdhary, L. Cohen R. Craig, L. DiCesare, M. Hernandez, L. Jacob, L. Matherne, C. Reyes, J. Roman, K. Schaefer, A. Tsega, M. Janes, X. Sheng, C. Quiñonez, M. Vera

23. www.gwu.edu/~mbp hnle@gwu.edu DHHS/HRSA/MCHB/Division of Research, Training and Education R40 MC 02497 Commun ity Partners: The Mary’s Center for Maternal and Child Care The Center for Life at Providence Hospital