Reducing symptoms of prenatal depression in an ethnically diverse group of rural low income women: A randomized clinical trial in progress

Background: Each year, as many as 50% of pregnant women experience depressive symptoms and about 11% develop antepartum depression (APD). Insight-Plus CBI (IP-CBI) is an innovative cognitive behavioral therapy intervention previously tested with a diverse group of low-income women. The program is delivered by a licensed mental health clinician and a case manager at the Local Health Department (LHD) and an affiliated clinic. Methods: This is an experimental two-group pre-test and post-test design. Chi-square tests of independence and independent-groups t-tests will be used to analyze differences in antepartum depressive symptoms (APDS) for women in the treatment group to APDS/APD symptoms to women in the treatment-as-usual (TAU) group after the last intervention session and at one month post intervention. Depressive symptoms are measured by the Edinburgh Postnatal Depression Scale (EPDS) and the MINI International Neuropsychiatric Interview. Results: Descriptive data includes 129 women out of a planned 140 participants who were interviewed at baseline. 68% were African-American and 32% Caucasian. Of these, 3% were Spanish speaking women who identified as ethnically Hispanic. Forty-four percent were at low-risk (EPDS 4-9) and 56% were at high-risk for APD (EPDS >10); 35% of the participants were diagnosed with APD. APDS and APD are major health issues. It is vital to develop interventions for these vulnerable women. Should this culturally tailored CBI prove to be feasible and effective, it will be a model for delivering care by public health staff and a model for care for low-income and minority women nationally.