Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY 10032, USA.
J Clin Psychiatry. 2013 Apr;74(4):393-9. doi: 10.4088/JCP.12m07909.
While treatment decisions for antepartum depression must be personalized to each woman and her illness, guidelines from the American Psychiatric Association and the American College of Obstetrics and Gynecology include the recommendation of psychotherapy for mild-to-moderate depression in pregnant women. Although we previously demonstrated the efficacy of interpersonal psychotherapy for antepartum depression in a sample of Hispanic women, this study provides a larger, more diverse sample of African American, Hispanic, and white pregnant women from 3 New York City sites in order to provide greater generalizability.
A 12-week bilingual, parallel-design, controlled clinical treatment trial compared interpersonal psychotherapy for antepartum depression to a parenting education program control group. An outpatient sample of 142 women who met DSM-IV criteria for major depressive disorder was randomly assigned to interpersonal psychotherapy or the parenting education program from September 2005 to May 2011. The 17-item Hamilton Depression Rating Scale (HDRS-17) was the primary outcome measure of mood. Other outcome scales included the Edinburgh Postnatal Depression Scale (EPDS) and the Clinical Global Impressions scale (CGI). The Maternal Fetal Attachment Scale (MFAS) assessed mother's interaction with the fetus.
Although this study replicated previous findings that interpersonal psychotherapy is a beneficial treatment for antepartum depression, the parenting education program control condition showed equal benefit as measured by the HDRS-17, EPDS, CGI, and MFAS.
This study supports the recommendation for the use of interpersonal psychotherapy for mild-to-moderate major depressive disorder in pregnancy. The parenting education program may be an alternative treatment that requires further study.
ClinicalTrials.gov identifier: NCT00251043
虽然产前抑郁症的治疗决策必须针对每位女性及其疾病进行个性化制定，但美国精神病学协会和美国妇产科学院的指南包括建议对孕妇的轻度至中度抑郁症进行心理治疗。尽管我们之前在西班牙裔女性样本中证明了人际心理治疗对产前抑郁症的疗效，但本研究提供了来自纽约市 3 个地点的更大、更多样化的非裔美国、西班牙裔和白人孕妇样本，以提供更大的普遍性。
一项为期 12 周的双语、平行设计、对照临床治疗试验比较了人际心理治疗对产前抑郁症与育儿教育计划对照组的效果。从 2005 年 9 月至 2011 年 5 月，符合 DSM-IV 重性抑郁障碍标准的 142 名门诊孕妇被随机分配到人际心理治疗或育儿教育计划组。汉密尔顿抑郁评定量表（HDRS-17）是情绪的主要结局测量指标。其他结局量表包括爱丁堡产后抑郁量表（EPDS）和临床总体印象量表（CGI）。母婴胎儿依恋量表（MFAS）评估了母亲与胎儿的互动。
尽管本研究复制了人际心理治疗对产前抑郁症有益的先前发现，但育儿教育计划对照组在 HDRS-17、EPDS、CGI 和 MFAS 测量中表现出同等的益处。
本研究支持在怀孕期间使用人际心理治疗轻度至中度重性抑郁障碍的建议。育儿教育计划可能是一种需要进一步研究的替代治疗方法。
ClinicalTrials.gov 标识符：NCT00251043
