Grote Nancy K, Swartz Holly A, Geibel Sharon L, Zuckoff Allan, Houck Patricia R, Frank Ellen
School of Social Work, University of Washington, Seattle, WA 98105, USA.
Psychiatr Serv. 2009 Mar;60(3):313-21. doi: 10.1176/ps.2009.60.3.313.
Depression during pregnancy is one of the strongest predictors of postpartum depression, which, in turn, has deleterious, lasting effects on infant and child well-being and on the mother's and father's mental health. The primary question guiding this randomized controlled trial was, Does culturally relevant, enhanced brief interpersonal psychotherapy (IPT-B) confer greater advantages to low-income, pregnant women than those that accrue from enhanced usual care in treating depression in this population? Enhanced IPT-B is a multicomponent model of care designed to treat antenatal depression and consists of an engagement session, followed by eight acute IPT-B sessions before the birth and maintenance IPT up to six months postpartum. IPT-B was specifically enhanced to make it culturally relevant to socioeconomically disadvantaged women.
Fifty-three non-treatment-seeking, pregnant African-American and white patients receiving prenatal services in a large, urban obstetrics and gynecology clinic and meeting criteria for depression on the Edinburgh Postnatal Depression Scale (score >12 on a scale of 0 to 30) were randomly assigned to receive either enhanced IPT-B (N=25) or enhanced usual care (N=28), both of which were delivered in the clinic. Participants were assessed before and after treatment on depression diagnoses, depressive symptoms, and social functioning.
Intent-to-treat analyses showed that participants in enhanced IPT-B, compared with those in enhanced usual care, displayed significant reductions in depression diagnoses and depressive symptoms before childbirth (three months postbaseline) and at six months postpartum and showed significant improvements in social functioning at six months postpartum.
Findings suggest that enhanced IPT-B ameliorates depression during pregnancy and prevents depressive relapse and improves social functioning up to six months postpartum.
孕期抑郁是产后抑郁最强的预测因素之一，而产后抑郁又会对婴幼儿的幸福以及父母的心理健康产生有害的长期影响。指导这项随机对照试验的主要问题是，与强化常规护理相比，具有文化相关性的强化简短人际心理治疗（IPT-B）对低收入孕妇治疗抑郁是否具有更大优势？强化IPT-B是一种旨在治疗产前抑郁的多成分护理模式，包括一次参与环节，随后在分娩前进行八次急性IPT-B治疗，产后长达六个月进行维持性IPT治疗。IPT-B经过专门强化，使其与社会经济弱势女性具有文化相关性。
在一家大型城市妇产科诊所接受产前服务且符合爱丁堡产后抑郁量表抑郁标准（0至30分的量表上得分>12）的53名未寻求治疗的非裔美国和白人孕妇，被随机分配接受强化IPT-B（N=25）或强化常规护理（N=28），两者均在诊所提供。在治疗前后对参与者进行抑郁诊断、抑郁症状和社会功能评估。
意向性分析表明，与接受强化常规护理的参与者相比，接受强化IPT-B的参与者在分娩前（基线后三个月）和产后六个月时抑郁诊断和抑郁症状显著减少，且在产后六个月时社会功能有显著改善。
研究结果表明，强化IPT-B可改善孕期抑郁，预防抑郁复发，并在产后长达六个月内改善社会功能。
