Intervention can prevent PPD in adolescents

April 30, 2013, Women & Infants Hospital

By targeting the factors that may play a significant role in the development of postpartum depression (PPD) in adolescent mothers, researchers at Women & Infants Hospital of Rhode Island believe they have found a way to prevent it.

The team – led by Maureen G. Phipps, MD, MPH, interim chief of obstetrics and gynecology and director of the Division of Research at Women & Infants, and Caron Zlotnick, PhD, of the hospital's Center for Women's Behavioral Health – recently published "Randomized controlled trial to prevent in adolescent mothers" in the American Journal of Obstetrics and Gynecology.

"Postpartum depression puts adolescent mothers and their children at risk in an already challenging time in their lives," Dr. Phipps explains. "This hardship may be a major determinant of poor outcomes for these young mothers and their children. Untreated, depression is associated with school dropout, suicide and substance abuse."

In addition, Dr. Phipps says adolescents who are depressed do not tend to focus on their baby's health or their own.

"Overall, children who are born to mothers with untreated depression show higher rates of developmental delays, lower levels of social engagement, increased stress reactivity, and negative interactions as compared with children of mothers who are not depressed," she adds.

Most teenage mothers with mental health problems are currently undertreated. The research team sought to test the effectiveness of an intervention called REACH (Relaxation, Encouragement, Appreciation, Communication, Helpfulness), adapted from an interpersonal therapy-based prevention intervention that had been found to reduce PPD in adults.

For this study, pregnant girls up to age 18 were recruited through Women & Infants' Womens Primary Care Center in 2007 and 2008. Half were enrolled in the REACH program, an intervention delivered over five one-hour sessions during pregnancy and one postpartum session that includes multimedia, interactive components, and homework with feedback. The other participants were part of the study's control group.

"REACH is designed to help the girls develop effective communication skills so they can manage relationship conflicts before and after the baby's birth, know what to expect from motherhood, manage stress, differentiate 'baby blues' from , develop a support system and healthy relationships, and set goals," Dr. Phipps says.

When all of the babies had been delivered and the postpartum visits were complete, researchers found that the incidence of PPD was 50% lower for the mothers in the REACH program compared with those in the control group.

"We believe this is the first clinical trial to prevent PPD in adolescent mothers and we are excited to report that the results show a positive trend supporting the interpersonal-based intervention program," Dr. Phipps says.

"With further evaluation, the REACH program has the potential to decrease disease burden for adolescent mothers and their children and to be a cost-effective alternative to the treatment of PPD."

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