Action-based postpartum TX effective in minorities

Postpartum depression affects thousands of American women annually, particularly black women and Latinas. But a randomized, controlled trial of minority women in New York City suggests that a 2-step behavioral intervention may be effective in helping them manage their depressive symptoms.

The study, conducted at a large, tertiary East Harlem hospital between April 2009 and March 2010, involved 540 women who had just given birth. Participants were self-identified as black and Latina women aged 18 to 46 years (mean age, 28 years) who spoke Spanish or English and who had a working telephone. All completed a baseline in-hospital survey and were randomly assigned to receive either enhanced usual care or a 2-step behavioral intervention. Depression symptoms were assessed using the Edinburgh Postnatal Depression Scale; mean baseline scores were 4.2 in the intervention group and 4.5 for controls. Forty-five of the 540 women were identified as having severe depressive symptoms and were referred for psychiatric assessment or treatment while in the hospital.

Prior to discharge, women in the behavioral arm had a 15-minute interview with a social worker, who reviewed a patient educational handout that listed potential triggers of depression represented as "normal" aspects of the postpartum experience and provided specific suggestions for management. In addition, participants were given a list of social support resources and had an opportunity to ask questions. Two weeks after leaving the hospital, they received a follow-up call from the social worker to assess their symptoms and their ability to manage symptoms, and the educational handout was discussed.

Both groups were surveyed again at 3 weeks, 3 months, and 6 months postpartum. Women in the intervention arm were less likely to have depressive symptoms than those in the control group: 8.8% vs 15.3% at 3 weeks (P=0.3), 8.4% vs 13.2% (P=0.9) at 3 months, and 8.9% vs 13.7% (P=0.11) at 6 months. Among the 495 women who did not receive additional psychiatric treatment, the trend held true: 7.1% vs 14.4% (P=0.01) at 3 weeks, 6.3% vs 11.4 (P=0.058) at 3 months, and 7.5% vs. 13.1% (P=0.068) at 6 months.

No significant between-groups difference in rates of postpartum depression was seen among the 45 women referred for additional care.

"The results suggest that one can address and modify the factors that have been reported to be correlated with and hypothesized to elicit postpartum depression," the authors write. "Our results are consistent with a large Cochrane review, which demonstrated that psychosocial interventions to prevent postpartum depression are more likely to be successful if they are individually based, initiated postnatally, and are conducted by a health professional."

Howell EA, Balbierz A, Wang J, Parides M, Zlotnick C, Leventhal H. Reducing postpartum depressive symptoms among black and latina mothers. Obstet Gynecol. 2012;119(5): 942-949.