Study Overview

Introduction

Dr. D. Elizabeth Jesse is funded by a grant from the National Institute of Mental Health (NIMH) to study ways to help women struggling with depressive symptoms/depression and life stress during pregnancy.

As many as 50% of pregnant women experience depressive symptoms and about 11% go on to develop prenatal depression (also called antepartum depression).1-2  Women with prenatal/antepartum depression experience more personal suffering and may have more stress and less social support.3 They are twice as likely to have postpartum depression and to have a premature birth than their non-depressed counterparts.4-6 African- American and low-income women and women who live in rural areas are more at risk. 7

What are the aims of the study?

Our study aims to improve mental health in pregnancy. If pregnant women feel better, they may not feel the negative consequences often experienced by those struggling with depression or other challenges in life. We want to know if Insight-Plus is an effective way to relieve women’s suffering from depression and symptoms of stress in pregnancy and if it is feasible and acceptable for a social worker (LCSW) and a resource mom (RM) to deliver the program in a local health department (LHD) and affiliated prenatal clinic.

Should the intervention prove to be feasible and effective, it will be a model for delivering care by public health staff and lay helpers and a model for care for low-income women nationally.

What is Insight-Plus?

Insight-Plus is a cognitive behavioral intervention for pregnant women adapted from a program designed by Verona Gordon, RN, PhD.8  This randomized clinical trial builds upon a previous small pilot study that found Insight-Plus was effective in reducing depressive symptoms in rural low-income and minority pregnant women.

Who is eligible for the study?

Women are eligible for the study if they attend the local health department’s (LHD) prenatal clinic or affiliated clinic at Brody School of Medicine and meet criteria for the study, including symptoms of depression as measured on the Edinburgh Postnatal Depression Scale (EPDS). 9

What will happen if women take part in the study?

In this study, women are randomly assigned to receive either usual care or the Insight-Plus group sessions.

The group sessions are led by caring and professional social workers or marriage and family therapists and a Resource Mom case manager who co-facilitates the groups and provides follow-up case management services. The pregnant women’s physical, emotional, behavioral, spiritual and cultural needs are considered. All women in the study receive information about prenatal and postpartum depression and services and resources in the community. They also receive incentives and have regular contact with trained staff. At the end of the study participants are given a mental health referral if one is needed.

References:

  1. Bennett, H.A., Einarson, A., Taddio, A., (2004) Prevalence of depression during pregnancy: Systematic review. Obstet Gynecol 103, 698-709.
  2. Gaynes, B.N., Gavin, N., Meltzer-Brody, S., Lohr, K.N., Swinson, T., Gartlehner, G., Brody, S., Miller, W.C. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence-based Practice Center, under Contract No. 290-02-0016.) AHRQ Publication No. 05-E006-2. Rockville, MD: Agency for Healthcare Research and Quality.
  3. Jesse, D. E. & Swanson, M. (2007) Risks and resources associated with antepartum risk for depression among rural southern women. Nursing Research, 56, 6, 378-386.
  4. Beck, C. T. (2008). State of the science on postpartum depression: What nurse researchers have contributed—part 1. MCN, American Journal of Maternal Child Nursing, 33(2), 121–126.
  5. Dennis, C. L., & Ross, L. (2006). The clinical utility of maternal self reported personal and familial psychiatric history in identifying women at risk for postpartum depression. Acta Obstetricia et Gynecologica, 85, 1179–1185.
  6. Li, D., Liu, L., & Odouli, R. (2009). Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: A prospective cohort study. Human Reproduction (Oxford, England), 24(1), 146–153.

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