Peripartum Depression: Efficacy of a Prenatal Prevention and Intervention Program

Abstract 607 Poster Session I, Saturday, 5/1 (poster 194)

Peripartum depression occurs frequently (15% in low risk, 45% in high risk groups) and is associated with significant adverse consequences for the fetus and infant. These adverse outcomes include the risk of a poor pregnancy outcome (low birth weight, prematurity), infant and childhood health, behavioral, and cognitive disorders. This study evaluates the efficacy of a pilot program in detecting and successfully treating peripartum depression. The pilot program was enacted in a high social risk obstetrical population. Methods: All mothers were screened for depressive symptomatology by the Center for Epidemiologic Studies Depression scale (CES-D) and four screening questions at the initial prenatal visit during the first trimester and with the CES-D serially thereafter. The CES-D is a twenty item scale measuring depressive symptomatology. Scores ≥ 16 (range 0 - 60) indicate above normal depressive symptomatology. When analyzing the group with high symptomatology, a score of 20 was used to minimize borderline symptomatology. The four screening questions were used to determine history and risk factors associated with peripartum depression. Mothers with any risk factors or elevated symptomatology were referred to a step-wise intervention program. Intervention ranged from educational sessions, group therapy, private counseling, to inpatient therapy. Results: The mean ± SD CES-D score was 23 ± 1. Prenatal symptomatology predicted postnatal symptomatology better than risk factors. Step-wise intervention was associated with a lowering of CES-D scores over time (ANOVA p < 0.01; n = 63). There were significant differences to intervention-treatment within the prenatal elevated depressive symptomatology group. Women with the preception of good social support and/or no history of previous peripartum depression had significant decreases in their CES-D scores over time (p<0.001). In contrast, women with a history of previous postpartum depression or poor social support did not significantly alter their symptomatology scores over time. This effect was not related to other factors such as severity of initial symptomatology, age, gravida, marital status, previous loss of child, or existing non-mental health disorder. Discussion: Perinatal depressive symptomatology occurs frequently. Response to intervention therapy is favorable, if the occurrence is a first time event or adequate social support exists. Improved intervention strategies may be necessary for symptomatic women without adequate support and/or a previous history of postpartum depression. Analysis is ongoing to determine whether prevention and intervention strategies affects pregnancy and child behavioral health outcomes.

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(Spon by: Michael Spear)

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Locke, R., Maxwell, M., Leatham, J. et al. Peripartum Depression: Efficacy of a Prenatal Prevention and Intervention Program. Pediatr Res 45, 105 (1999).

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