Posmontier Bobbie, Neugebauer Richard, Stuart Scott, Chittams Jesse, Shaughnessy Rita
J Midwifery Womens Health. 2016 Jul;61(4):456-66. doi: 10.1111/jmwh.12411. Epub 2016 Mar 10.
Postpartum depression (PPD) affects 7% to 13% of childbearing women. Access to care may be limited by maternal time constraints and fears of being judged, labeled as mentally ill, and having their infants taken away. The study's objective was to test the feasibility, effectiveness, and acceptability of certified nurse-midwife telephone-administered interpersonal psychotherapy (CNM-IPT) as a treatment for PPD.
A prospective cohort study was conducted from 2010 to 2014. A sample of women meeting Diagnostic and Statistical Manual of Mental Disorders, Version 4, Text Revision (DSM-IV-TR) criteria for depression was recruited from 8 obstetric practices employing CNMs in the United States. Forty-one women in the treatment group received up to eight 50-minute CNM-IPT sessions, and 20 in the control group were referred to mental health professionals. The main outcome measure was the Hamilton Rating Scale for Depression. Secondary outcomes included maternal and marital functioning, mother-infant bonding, social support, and client satisfaction.
The Hamilton Rating Scale for Depression at 8 and 12 weeks was significantly lower among women in the treatment group compared to the control group (Week 8, P = .047; Week 12, P = .029). Client satisfaction was high in both groups. While only 5 out of 8 CNM-IPT counselors continued the intervention until the study's conclusion, CNM-IPT counselor protocol adherence was high.
CNM-IPT is effective and acceptable as a method of reducing the severity of PPD symptoms. Careful assessment of CNM availability is critical to intervention feasibility. Future research is needed to evaluate translation of this intervention into practice.
产后抑郁症（PPD）影响着7%至13%的育龄妇女。由于产妇时间有限，且担心被评判、被贴上精神疾病的标签以及婴儿被带走，她们获得护理的机会可能受到限制。本研究的目的是测试由认证助产士通过电话进行的人际心理治疗（CNM-IPT）作为PPD治疗方法的可行性、有效性和可接受性。
2010年至2014年进行了一项前瞻性队列研究。从美国8家雇佣了认证助产士的产科诊所招募了符合《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）抑郁症标准的女性样本。治疗组的41名女性接受了多达8次每次50分钟的CNM-IPT治疗，对照组的20名女性被转介给心理健康专业人员。主要结局指标是汉密尔顿抑郁量表。次要结局包括产妇和婚姻功能、母婴联结、社会支持和客户满意度。
与对照组相比，治疗组女性在第8周和第12周的汉密尔顿抑郁量表得分显著更低（第8周，P = 0.047；第12周，P = 0.029）。两组的客户满意度都很高。虽然8名CNM-IPT咨询师中只有5名继续干预直至研究结束，但CNM-IPT咨询师对方案的依从性很高。
CNM-IPT作为减轻PPD症状严重程度的一种方法是有效且可接受的。仔细评估认证助产士的可用性对干预的可行性至关重要。未来需要开展研究来评估将这种干预措施转化为实际应用的情况。
