Depression Surrounding Pregnancy Treated With Interpersonal Therapy: Researcher Insights from a Randomized Clinical Trial

Pregnancy is a vulnerable time for mothers with or without a previous psychiatric history, and new research has shown interpersonal therapy to be a useful intervention for depression surrounding pregnancy. Researchers Elysia Davis, PhD, and Benjamin Hankin, PhD, shared insights about their recent randomized clinical trial with Psychiatric Times.

Psychiatric Times: Can you provide a brief overview of the data and results from your recent paper “Enduring effects of brief interpersonal therapy on depression from pregnancy through 1-year postpartum: a randomized clinical trial”?

Elysia Davis, PhD; and Benjamin Hankin, PhD: In this randomized clinical trial, which we named The Care Project, we initially recruited 234 pregnant individuals, identified, using standard of care depression screening administered by their obstetrics clinic, as having elevated depression symptoms. Participants were recruited from obstetric visits relatively early in their pregnancy, and 37% of these pregnant people had a diagnosis of major depressive disorder (MDD) at recruitment into the project. Half of the individuals were randomized to brief interpersonal therapy (IPT) and the other half to an active comparison condition of enhanced usual care (EUC). Results from this RCT evaluating depression outcomes during pregnancy showed that IPT substantially and quickly reduced depression symptoms compared to EUC, as well as cut MDD rates to 6%.

The main question was whether the depression reduction effects observed during pregnancy would be maintained throughout the first postpartum year, and the answer was yes!

Participants randomized to IPT during pregnancy showed enduring effects of less depression during the first 12 months postpartum, with an average MDD rate of 4.4%, compared to people randomized to EUC, who showed MDD an average rate around 13%.

PT: Do these findings indicate that interpersonal therapy has potential as a treatment for postpartum depression?

Drs Davis and Hankin: Yes, the results of the Care Project show that brief interpersonal therapy demonstrates efficacy as a treatment for perinatal depression, including during pregnancy as well as ongoing relapse prevention treatment for postpartum depression through the first year.

PT: What inspired your investigation into this specific intervention for this population?

Drs Davis and Hankin: Considerable evidence over years shows that many individuals during the broad perinatal period, including pregnancy and postpartum, experience elevated levels of various psychopathologies, including depression. The effects of higher stress and depression affect the mother as well as confer risk to offspring for mental as well as physical health outcomes. We launched the Care Project to examine whether we could reduce depression and related mental health problems during pregnancy to help both the individuals throughout pregnancy and postpartum, as well as their offspring early in life. The main idea was to provide an experimental test, using an RCT design, to investigate whether reducing stress and depression during pregnancy could improve health and well-being for the adults throughout the perinatal period as well as their offspring.

PT: What is the most important element of your findings that practicing clinicians should keep in mind?

Drs Davis and Hankin: For practicing clinicians, a key takeaway is that a relatively brief, safe, effective psychological intervention, namely brief interpersonal therapy, can considerably and quickly reduce depression symptoms and MDD during pregnancy, which helps the pregnant individual as well as the fetal development. Brief IPT then exerts ongoing, enduring depression reduction effects throughout the first year postpartum. Not only does brief IPT reduce depression and other mental health problems for the pregnant individuals, but we are seeing significant results that affect their offspring, including longer gestation due to reducing depression symptoms during pregnancy, as well as offsprings’ brain development early in life as assessed via MRI in the first month of life. Our study provides important evidence that by giving mental health support during pregnancy, we can improve the health of both mother and baby.

PT: What do you hope the next steps of research are in this area?

Drs Davis and Hankin: Next steps are to investigate the effects of IPT for other forms of psychopathology, such as anxiety, trauma reactions, inattention, hyperactivity, etc. that often co-occur depression during the perinatal period to evaluate how well brief IPT can reduce overall mental health. Additionally, we are following up the mothers and their offspring until the children are 5 years of age to examine effects on the children, including their emotional, behavioral, and cognitive developmental outcomes, and various biopsychosocial processes that may affect offspring outcomes, such as MRI, EEG, stress hormones, attention, and more. A major part of the current ongoing follow-up in the Care Project involves investigating how reducing maternal stress and depression during pregnancy additionally influences physical health for the mother and offspring. We are currently evaluating the hypothesis that reducing stress and depression during pregnancy can also minimize cardiovascular health for the mother and her child.

Dr Davis is a distinguished university professor in the Psychology Department at the University of Denver, and director of the Stress Early Experiences and Development Research Institute. Davis is a developmental psychologist who investigates the early origins of lifespan health and disease with an emphasis on the prenatal period. The broad goal of this research program is to work in collaboration with community partners to promote parent-child health and to provide training and opportunities for the next generation of scientists.

Dr Hankin is the Fred and Ruby Kanfer professor of psychology at the University of Illinois. As a clinical psychologist, his research takes a developmental psychopathological approach to understand risk factors and mechanisms in depression and related internalizing emotional disorders across the lifespan, including parents and offspring. He is interested in translating knowledge on risk and vulnerability to psychopathology into evidence-based assessment and interventions, including personalizing preventions and treatments, for individuals and families across the lifespan.