Abstract
Background/Aims Perinatal depression is both prevalent and associated with adverse correlates and consequences for women and offspring. Women and their health care providers often face complex choices regarding treatment of depression during pregnancy. Although studies suggest that pregnant women express a preference for psychotherapy over antidepressants, the latter is most frequently provided. These treatment patterns highlight the need for evidence-based psychotherapies with broad dissemination potential. We report preliminary results from a multi-site randomized trial comparing the effectiveness of brief Behavioral Activation (BA) therapy to usual care for women with elevated depressive symptoms during pregnancy.
Methods Women receiving prenatal care at Kaiser Permanente Colorado and Georgia, Group Health Cooperative, and HealthPartners (N = 163) were screened for depressive symptoms prior to or at their OB visit. Those with scores ≥ 10 on the PHQ-9 were recruited, consented, and randomized to receive 10 sessions of BA (N = 85) or usual care (N = 78). Obstetric nurses and behavioral health providers were trained to deliver BA by telephone, in the obstetrics clinics, or in patients’ homes. Participants’ mean age was 28, 37% (64/163) were pregnant with their first child, 47% (76/163) were non-White, and 15% (25/163) were Hispanic ethnicity. A majority (63%, or 102/163) reported receiving prior treatment for depression. There were no differences in demographic or clinical characteristics between the BA and usual care groups. The primary outcome measure was change in depression symptoms on the PHQ-9, obtained via a centralized web-based survey 10 weeks following randomization.
Results Mean baseline PHQ-9 scores for the BA and usual care groups were 14.9 (95% CI 14.1, 15.7) and 14.4 (95% CI 13.7, 15.2), respectively. Women randomly assigned to BA reported significantly greater improvement than women in usual care; mean PHQ-9 scores for the BA and control groups were 8.5 (95% CI 7.2, 9.8) and 10.3 (95% CI 9.1, 11.5), respectively (P = .04), and 46.5% (33/71) of the BA group had a 50% or greater reduction in PHQ-9 scores, vs. 30.4% (21/69) of the control group (P = .05).
Conclusions Behavioral activation may be an effective and feasible treatment for depressed pregnant women, with broad dissemination potential.
