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

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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.

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Acknowledgments

The authors thank the White Mountain Apache women who participated in this study and the White Mountain Apache leaders and community stakeholders who generously contributed their time and wisdom to designing the intervention and research protocol and reviewing the article. This study was funded by an NIMH grant (MH071300, G. Ginsburg, PI).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Golda S. Ginsburg

  2. Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA

    Allison Barlow, Novalene Goklish, Ranelda Hastings, Elena Varipatis Baker & Britta Mullany

  3. Department of Psychology, Arizona State University, Tempe, AZ, USA

    Jenn-Yun Tein

  4. Department of Psychiatry, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA

    John Walkup

Authors
  1. Golda S. Ginsburg
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  2. Allison Barlow
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  3. Novalene Goklish
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  4. Ranelda Hastings
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  5. Elena Varipatis Baker
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  6. Britta Mullany
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  7. Jenn-Yun Tein
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  8. John Walkup
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Corresponding author

Correspondence to Golda S. Ginsburg.

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Ginsburg, G.S., Barlow, A., Goklish, N. et al. Postpartum Depression Prevention for Reservation-Based American Indians: Results from a Pilot Randomized Controlled Trial. Child Youth Care Forum 41, 229–245 (2012). https://doi.org/10.1007/s10566-011-9161-7

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  • DOI: https://doi.org/10.1007/s10566-011-9161-7

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