Performance of a Culturally Tailored Cognitive‐Behavioral Intervention Integrated in a Public Health Setting to Reduce Risk of Antepartum Depression: A Randomized Controlled Trial

Abstract

Introduction Cognitive‐behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6‐week, culturally tailored, cognitive‐behavioral intervention offered to rural, minority, low‐income women at risk for antepartum depression. Methods A total of 146 pregnant women were stratified by high risk for antepartum depression (Edinburgh Postnatal Depression Scale [EPDS] score of 10 or higher) or by low‐moderate risk (EPDS score of 4‐9) and randomized to a cognitive‐behavioral intervention or treatment as usual. Differences in mean change of EPDS and Beck Depression Inventory (BDI)‐II scores for low‐moderate and high‐risk women in the cognitive‐behavioral intervention and treatment as usual for the full sample were assessed from baseline (T1), posttreatment (T2), and one‐month follow‐up (T3), and for African American women in the subsample. Results Both the cognitive‐behavioral intervention and treatment‐as‐usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high risk for depression (n = 62), there was no significant treatment effect from T1 to T2 or T3 for the EPDS. However, in low‐moderate risk women, there was a significantly greater mean change in the BDI‐II scores from significant decrease in the BDI‐II scores from T1 to T2 (4.92 vs 0.59, P = .018) and T1 to T3 (5.67 vs 1.51, P = .04). Also, the cognitive‐behavioral intervention significantly reduced EPDS scores for African American women at high risk (n = 43) from T1 to T2 (5.59 vs 2.18, P = .02) and from T1 to T3 (6.32 vs 3.14, P = .04). Discussion A cognitive‐behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment as usual, the cognitive‐behavioral intervention reduced depressive symptoms for African American women at high risk for antepartum depression and for the full sample of women at low‐moderate risk for antepartum depression. These promising findings need to be replicated in a larger controlled clinical trial that incorporates methods to maintain greater participant engagement.