Benjamin L. Hankin, PhD

Credit: University of Illinois

New research suggests interpersonal psychotherapy is a better option for reducing depressive symptoms than enhanced usual care for pregnant individuals.¹

A team, led by Benjamin L. Hankin, PhD, University of Illinois, evaluated depression improvement among pregnant individuals from diverse backgrounds randomized to brief interpersonal psychotherapy compared to enhanced usual care.

“Prenatal maternal depression confers intergenerational risks, including preterm birth as well as developmental delays, and enhanced vulnerability to psychopathology in offspring,” the authors wrote. “The Perinatal Depression Task Force of the American College of Obstetricians and Gynecologists highlighted the need for early screening of depression and intervention during pregnancy.”

The Study

In the prospective, evaluator-blinded, randomized clinical trial called the Care Project, the investigators examined adult pregnant individuals who reported elevated symptoms during routine obstetric care depression screening in general practice in obstetrics and gynecology (OB/GYN) clinics between July 2017 and August 2021.

The investigators looked at repeated measures follow-up across pregnancy from baseline (mean, 16.7 gestational weeks) through term.

Each treatment comprised of an engagement session, as well as 8 active sessions of brief interpersonal psychotherapy during pregnancy.

The enhanced usual care group included engagement and maternity support services.

The investigators sought main outcomes of 2 depression symptom scales—the 20-Item Symptom Checklist and the Edinburgh Postnatal Depression Scale. These were assessed at baseline and repeatedly throughout the pregnancy. The team also used the Structured Clinical Interview for DSM-5 to diagnosed major depressive disorder (MDD) at baseline and the end of gestation.

The study included 234 patients, 115 in the interpersonal psychotherapy group with a mean age of 29.7 and 119 in the enhanced usual care group with a mean age of 90.1 years. In addition, 49.6% (n = 57) of the interpersonal psychotherapy group were enrolled in Medicaid and 36.5% (n = 42) had current MDD, while 92.2% (n = 106) received intervention. For the enhanced usual care group, 52.1% (n = 62) were enrolled in Medicaid and 37% (n = 44) had MDD.

Comparing the 2 Groups

The results show scores for the 20-Item Symptom Checklist improved from baseline over gestation in the interpersonal psychotherapy, but not in the enhanced usual care group (d = 0.57; 95% confidence interval [CI], 0.22-0.91; mean change for IPT, 26.7-13.6; mean change for EUC, 27.1-23.5).

In addition, patients in the interpersonal psychotherapy group more rapidly improved on the Edinburgh Postnatal Depression Scale compared to the enhanced usual care group (d = 0.40; 95% CI, 0.06-0.74; mean change for IPT, 11.4-5.4; mean change for EUC, 11.5-7.6).

The rate of MDD by end of gestation had decreased significantly for participants interpersonal psychotherapy (n = 7; 6.1%) compared to the enhanced usual care (n = 31; 26.1%; odds ratio [OR], 4.99; 95% CI, 2.08-11.97).

“In this study, brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics,” the authors wrote. “As a safe, effective intervention to relieve depression during pregnancy, brief IPT may positively affect mothers’ mental health and the developing fetus.”

References:

Hankin BL, Demers CH, Hennessey EP, et al. Effect of Brief Interpersonal Therapy on Depression During Pregnancy: A Randomized Clinical Trial. JAMA Psychiatry. Published online April 19, 2023. doi:10.1001/jamapsychiatry.2023.0702