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Postpartum Depression Prevention for Reservation-Based American Indians: Results from a Pilot Randomized Controlled Trial

Abstract

Background  

Postpartum depression is a devastating condition that affects a significant number of women and their offspring. Few preventive
interventions have targeted high risk youth, such as American Indians (AIs).

Objective  

To evaluate the feasibility of a depression prevention program for AI adolescents and young adults.

Methods  

Expectant AI women (mean age = 18.15; N = 47) were randomized (1:1) to either the Living in Harmony program (LIH, an 8 lesson cognitive-behaviorally based program) or an Educational–Support program (ES, an 8 lesson education program).
Both interventions were delivered by AI paraprofessionals. Adolescents were evaluated during their pregnancy at baseline,
at post-intervention, and at 4, 12, and 24 weeks postpartum. The primary outcome measure was the Center for Epidemiological
Studies–Depression scale (CES-D). Additional measures of depression included the onset of major depressive disorder (MDD;
assessed via computerized diagnostic interview) and the Edinburgh Postpartum Depression Scale (EPDS). Secondary outcomes included
changes in mothers’ global functioning and social support.

Results  

At all post intervention assessments, mothers in both groups showed similar reductions in depressive symptoms and similar
rates of MDD (0 and 6% in LIH and ES respectively). Both groups of participants also showed similar improvements in global
functioning. No changes in either group were found on the measure of social support.

Conclusions  

Findings suggest that both paraprofessional-delivered interventions may reduce symptoms of depression among AIs. Replication
with a larger sample, a usual care control condition, blinded evaluators, and a longer follow-up is needed.

  • Content Type Journal Article
  • Category Original Paper
  • Pages 1-17
  • DOI 10.1007/s10566-011-9161-7
  • Authors
    • Golda S. Ginsburg, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    • Allison Barlow, Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
    • Novalene Goklish, Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
    • Ranelda Hastings, Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
    • Elena Varipatis Baker, Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
    • Britta Mullany, Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
    • Jenn-Yun Tein, Department of Psychology, Arizona State University, Tempe, AZ, USA
    • John Walkup, Department of Psychiatry, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA