Interpersonal Therapy May Prevent Postpartum Depression

Interpersonal therapy reduces risk of postpartum depression in mothers on public assistance during first 6 months after giving birth

Shannon Peters
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A new study, published in the Journal of Affective Disorders, examines the effect of interpersonal therapy on reducing the development of postpartum depression in mothers on public assistance. The results of the blinded, randomized controlled trial indicate that interpersonal therapy reduces the risk of postpartum depression during the first 6 months after mothers give birth.

“Pregnancy provides an opportunity to initiate a preventive intervention that could impact the health and well-being of both mother and infant, reducing the burden of disease,” write the researchers, led by Caron Zlotnick, psychologist at Women and Infants Hospital in Rhode Island and honorary professor at University of Cape Town in South Africa.

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Studies show that 10-15% of women who have recently given birth experience postpartum depression, with higher rates for financially disadvantaged mothers. Accessing effective treatments can be especially difficult for mothers who identify as low-income. In addition, many women who are breastfeeding may not want to take one of the most common treatments for depression—antidepressant medication.

Psychosocial interventions have been shown to decrease the likelihood that women will experience postpartum depression. Interpersonal therapy (IPT) is a psychosocial intervention that has been empirically shown to treat major depression. The authors of the current study suggest that IPT may be beneficial for reducing the risk of developing postpartum depression:

“IPT-based interventions target those factors that appear to play a role in PPD [postpartum depression] (e.g., social support, role transitions, life stressors).”

The authors had previously conducted two pilot studies to test whether IPT can help prevent postpartum depression and found positive results. The current study uses a larger sample of pregnant women who were on public assistance and deemed at risk for postpartum depression “to examine the efficacy of this IPT-based intervention on reducing the risk of PPD [postpartum depression].”

The researchers conducted a longitudinal, blinded, randomized controlled trial to compare rates of developing postpartum depression in 104 women who received IPT versus 101 women who received treatment as usual. Mothers were followed up to 12 months post-delivery and were considered to have developed postpartum depression if they experienced a major depressive episode within 6 months of giving birth.

The IPT intervention was the Reach Out, Stand strong, Essentials for new mothers (ROSE) Program. ROSE includes 4 group sessions over 4 weeks during pregnancy, as well as a booster session 2 weeks post-delivery. The authors describe the program:

“The content of the intervention focuses on managing role transitions with an emphasis on transition to motherhood, developing a support system, developing effective communication skills to manage relationship conflicts before and after the birth of their baby, goal setting, and psychosocial resources for new mothers.”

Participants were an average age of 22.7 years old. The majority of women identified as single (46% of control group; 60% of intervention group). Over a third (38%) of participants identified as Latina, with 28% identifying as Caucasian, and 23% identifying as Black.

Almost twice as many participants in the control group (31%) developed postpartum depression compared to the group who received IPT (16%). This difference was found to be statistically significant (p = 0.041). Over the 12 months of observation, 40% of participants in the control group and 26% of participants in the intervention group experienced a major depressive episode. The authors describe this effect as “marginally significant (p = 0.052).” The researchers acknowledge a limitation that women in the IPT group received a greater amount of contact with providers than women in the control group, and this may have contributed to reduced rates of postpartum depression.

The results of this larger study bolster findings from the researchers’ pilot studies and continue to suggest that IPT is an effective preventative treatment for postpartum depression. The authors highlight that “the first 6 months after delivery is considered a time of elevated risk and vulnerability for unipolar depression” and therefore having a treatment that reduces risk during this period “is potentially impactful in relation to the social and economic burden of the disease.”

“The delivery of the ROSE Program during pregnancy may be optimal timing given that women are in regular contact with health professionals and are motivated to make changes to benefit the health outcome of the baby,” suggest the authors.

As of January 2016, the United States Preventive Services Task Force (USPSTF) “recommends screening for depression in the general adult population, including pregnant and postpartum women.” Many have concerns about this recommendation, mainly that more screening will lead to more pregnant and postpartum women being prescribed antidepressants. Therefore, it is important to have alternative treatments that can be offered to pregnant and postpartum women who screen positive for depression. Zlotnick and colleagues provide important RCT-based evidence to support IPT as one of those alternatives.

 

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Zlotnick, C., Tzilos, G., Miller, I., Seifer, R., & Stout, R. (2016). Randomized controlled trial to prevent postpartum depression in mothers on public assistance. Journal of Affective Disorders, 189, 263-268. http://dx.doi.org/10.1016/j.jad.2015.09.059 (Abstract)

14 COMMENTS

  1. It might also be beneficial to supplement these women’s diets with zinc and B6 for the first few months after the end of pregnancy. White spots in nails would be an indicator to use such a program- the late Carl Pfeiffer believed such spots (or even white nails) were a sign of zinc deficiency.

  2. Absolutely it is unwise to give young mothers antidepressants. I would say not just unwise, but downright evil at this point in time, given the medical evidence of the antidepressants potential harm to people of all ages.

    https://www.madinamerica.com/2017/02/editorial-misconduct-finnish-medical-journal-rejects-paper-suicide-risk/

    Why in the world would doctors want to destroy the lives of young, low income, struggling, single mothers? What an incredible abuse of power. I absolutely agree, “it is important to have alternative treatments that can be offered to pregnant and postpartum women who screen positive for depression.”

  3. Poverty is the number one risk factor for postpartum depression. It makes a lot more sense to figure out how to lift mothers out of poverty than it does to see what amount of “absolutely no help whatsoever” might make them more resilient. It’s time for a minimum basic income.

  4. Odd that they identify increased contact with providers as a confounding factor. Isn’t that the point? That contact with caring people reduces feelings of isolation and hopelessness?

    And notice we’re talking about 6 group sessions, four before and two after the birth. There is no specific intervention based on the needs of the specific mother in question. And despite this, double the number in the control group fell into deep depression in the control group.

    Given the anemic response level for antidepressants, the broad side effect profile, and the lack of any evidence of long-term advantage, even within psychiatry’s own warped viewpoint, this intervention is clearly superior. What would happen if someone actually paid some individual attention to the mothers’ specific stressors and helped them plan for their families’ futures?

    — Steve

  5. For a child, a mother’s postpartum depression can be fatal. Whole chapter dedicated to this:

    https://www.amazon.com/Fatal-Families-Dynamics-Intrafamilial-Homicide/dp/0761907580/ref=sr_1_fkmr0_3?s=books&ie=UTF8&qid=1487885166&sr=1-3-fkmr0&keywords=fatal+families+c.+p.+ewing

    The reason this is so common is that the middle-class lives in bad faith. It has children deliberately, but it is people not admitting to themselves that they have choice.

    So what we need is to expose this, not to use psychotherapy to cover it up.

    Nomadic

    Please Join:
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    • “For a child, a mother’s postpartum depression can be fatal.”

      That’s a myth on the same order of the kind that says mental illness causes gun violence. Postpartum psychosis, which can be dangerous, is exceedingly rare, and occurs in about 1% of those who experience PPD, and almost exclusively in those with a history of psychosis. It is this myth that keeps many women from seeking help because they fear losing their child.

      The book you shared is incredibly sensational – along with some of the authors other books such as “Battered Women Who Kill”. That title could be rewritten as “Battered Women Who End The Abuse Permanently When Nobody Else Would”.

      • I agree. “Postpartum depression” is an invention to cover the fact that we set up mothers for stress and disappointment in our oppressive society. It is a fact that certain cultures have essentially ZERO cases of “postpartum depression.” mostly because they provide continuous and ongoing support for the mom and baby after birth. “Postpartum depression” is a Western industrial society disease that is a function of how we treat new moms and babies. It is NOT because of hormones – it’s because of unresolved stress in 99% of cases.

        — Steve

        • Kindred, parents kill their children at a very high rate. Children kill their parents too, but the rate of the latter is only 10% of the former.

          In any event, it all comes from the lies upon which the middle-class family is built. It only exists because it is allowed to exploit and abuse children. In our society, children are the exploited workers, being used to give identity to their parents.

          Psychotherapy is part of the problem, not part of the solution. It is a way of turning the blame back onto the victim, turning their experience of injustice into a medical problem and a self improvement project.

          The problem actually starts with the marketing of parenthood, via the pedagogy manuals:
          https://www.amazon.com/Beyond-Sling-Real-Life-Confident-Attachment-ebook/dp/B005FLOF28/ref=asap_bc?ie=UTF8

          We need to fight back, but it has to be against the entire Mental Health, Recovery, and Life Coaching Industry. Otherwise we are still promoting parts of the problem. We are still encouraging people to be Uncle Toms.

          Please Join:
          http://freedomtoexpress.freeforums.org/index.php

          Nomadic

          Tom Tomorrow, This Modern World
          http://www.dailykos.com/blog/tom%20tomorrow

          • “Parents kill their children at a very high rate”

            Nomadic, that is, simply put, an alternative fact.

            We were talking about the potential dangers of PPD not filicide in general. But here are some facts on both. There are about 500 filicides in the us every year. Fifty-six percent of which are committed by fathers. Twenty percent of children killed by their parents are already adults. Of infanticide victims, that is those under one year old killed during the postpartum period, the rate is about 4.3 deaths per 100,000 live births- and that’s by both parents – maternal infanticide happens at about 2.5-3 per 100,000. Neonaticide – the killing of a baby less than 24 hours old, is the most rare and is usually restricted to cases of very young mothers who either did not know or have not told anyone they were pregnant. This is typically the purview of unmarried teen mothers. Approximately 1% of women who suffer ppd will develop postpartum psychosis. But only about 4% of that 1% kill their babies. That is a tiny number that you are blowing out of proportion.

            These tactics serve only one purpose and that is to prevent women who need help from seeking it out. Perpetuating myths about the dangers of ppd or the “very high” rate of filicide, will scare women from seeking support because it perpetuates the notion that they are a danger to their child.

            I get your beef with parents. I happened to have two quite shitty ones as an example myself. But misleading people to think parents are inherently dangerous to their kids is wrong – morally as well as its not factual. There are less than 500,000 children in foster care nationwide – just about .5% of under 18s. The number of infanticides each year attributable to ppd/ppp is FAR under this low .5% number.Sorry, your “very high” description does not add up when presented against the evidence.

            Here is an article that spells out some of the reasons why mothers kill their children. It also explains how extremely rare this phenomena actually is, especially compared with other mammals.
            https://www.washingtonpost.com/amphtml/local/what-makes-mothers-kill-their-children/2014/09/27/f599f0b4-4018-11e4-b03f-de718edeb92f_story.html

            Finally, links to books on Amazon do not provide evidence for your statements. I also don’t think you know the first thing about attachment or attachment disorders. Im a RADmom and Ive lived through the horrors of a RADchild and the normal issues of a healthy child. Healthy attachments are much more complicated than the magic formulas in new parent books would have you believe. There is a strong genetic role in attachment. My RADgirl’s bio dad, whom she did not know about until she was an adult, is in prison for a rather grisly murder, and is diagnosed with full-blown sociopathy. Had I known all this when she was a baby, we certainly would have taken extra efforts early on. But like most RADbabies, she was extremely non-demanding. Everyone commented on what a happy pleasant baby she was. Attachment is presented to new parents as a sort of magic formula – put in certain inputs and specific outputs are sure to follow. Attachment just doesn’t work that way. Theres an assumption that healthy attachments are the norm and anything that deviates is somehow caused by poor parenting. But what I have is an attachment parented child who followed in the footsteps of her sociopathic biological father and whose threats to kill others have to be taken seriously. And I have a normal child in the process of applying to Ivy League colleges next year. They were both worn in slings, breastfed, coslept, cues answered. But my older daughter started out different and the similarities to her father can’t be ignored just so we can parade the nonsense that genetics and biology have nothing to do with how kids turn out. Im done with the parent-bashing because it rarely tells us anything useful about the child’s or adult patient’s current behavior even in the cases where the parent’s behavior was directly causative.

  6. Kindred, the filicide rate is about 10x what you are quoting. It is about the only FBI stat which is still an under count, because the deaths get written off to natural causes.

    The parricide rate for the entire US is about 200 to 500 per year, with around 2/3 of those being committed by juveniles. Parricide accounts for about 2% of the general homicide rate. It means that in a metro of 1 million persons, it will average about 1 parricide per year. Watching local news for this now, I would say that it is at least this, though this type of crime is grossly under reported on.

    I got to meet this man and shake his hand in front of a court house:
    https://www.amazon.com/When-Child-Kills-Paul-Mones/dp/0671674218/ref=sr_1_3?ie=UTF8&qid=1488239288&sr=8-3&keywords=paul+mones
    Besides parricide, he also talks about the filicide rate.

    And then this talks about parricide and filicide:
    https://www.amazon.com/Fatal-Families-Dynamics-Intrafamilial-Homicide/dp/0761907599/ref=sr_1_7?s=books&ie=UTF8&qid=1488239392&sr=1-7&keywords=charles+patrick+ewing

    In particular, he talks about parents murdering very small children. And then there is another chapter about parents murdering children a few years older.

    And then at least in some states we have these no questions asked infant drop off centers. Hospitals, Police, and especially Fire Houses. Most people live within a short walk to a Fire House. And they have an interesting graphic for their signs.

    It’s kind of like the logo for this:
    http://www.nationalsafehavenalliance.org/

    http://www.wikihow.com/Drop-Off-an-Unwanted-Baby

    And then I am told that in much of Europe, or at least the UK, they have written into their laws a maternal absolution for homicide for about the first 2 weeks of a child’s life.

    Now, I have to state about C. P. Ewing, he never uses the term Post Partum Depression. And if you were to ask me, I would say that just like all these mental illness conditions, I think we should drop that term.

    Like Peter Breggin says, people are depressed because they lead depressing lives. Usually career and marriage.

    So if we look at it this way, then what is causing this?

    Well, the middle-class family is unlike anything which has ever before existed. People are having children by choice, and they are doing it to enhance their social status, but they are not being honest about it. It’s like everything else about the middle-class, it lives in Bad Faith.


    Bad faith (from French mauvaise foi) is a philosophical concept used by existentialist philosophers Jean-Paul Sartre and Simone de Beauvoir to describe the phenomenon where human beings under pressure from social forces adopt false values and disown their innate freedom, hence acting inauthentically. It is closely related to the concepts of self-deception and ressentiment.

    https://en.wikipedia.org/wiki/Bad_faith_(existentialism)

    Another way to put it would be to say that people are not living up to their own values, not admitting that they create their own values.

    And then who could ever forget South Carolina’s Susan Smith,
    https://usercontent1.hubstatic.com/4955540_f260.jpg

    and her tearful performance?
    https://www.youtube.com/watch?v=5JLz37EAAow

    All she had to do was drop the kids off with their father and take her car to Cash For Cars, and she could have been on a plane to Europe to be with her rich boyfriend.

    But no she could not do that because she was attached to this Suffering Good Mother identity.

    So black males are being stopped and stopped, all over the eastern half of the country, and with no end in sight. So finally law enforcement recognized that she was attached to her public persona and to being believed. But they saw that there were contradictions in her story, about the timing of a traffic light. And the outcome, someone holding on to the kids this long, was improbable. No traces of the kids, not traces of the car.

    So they told her that they didn’t believe her, and that if they didn’t get some straight answers they were going to call a news conference and tell the whole world that they didn’t believe her. So they asked her, “Where is the car?”

    Finally, “Well, it might be at the bottom of the John D. Lake.”

    About the children who have been murdered, there is nothing we can do. But also understand that for every such case there have got to be at least 1000 more where it doesn’t actually go to murder, but there is still an extremely negative and abusive dynamic in play.

    And it is always the child who will end up being on alcohol, prescription drugs, or street drugs, and it is the child who will end up being further abused in psychiatry, psychotherapy, recovery programs, and evangelical churches. And it is the child who gets a psychiatric or learning disabilities label, or they call it attachment disorder.

    I am not trying to diminish the role of fathers in all of this, not at all. What I really want is for people to understand that the middle-class lives in bad faith, and that those who suffer the most for this are the children. The middle-class family made children into private property, and into the exploited workers, providing a social identity for their parents.

    http://faculty.humanities.uci.edu/poster/CTF/
    Readily available on paper as well.

    Nomadic

    Stop collaborating with Recovery and the Mental Health System. Please Join:
    http://freedomtoexpress.freeforums.org/postpartum-depression-honesty-or-more-theapy-t436.html

  7. Kindred, I think the issue here is not the number of filicides or parricides. Rather the issue is, do we go along with this idea of Post Partum Depression?

    Well, like with all depression, talking about it that way makes it sound like a mental illness, and something which should be corrected by psychotherapy. I do not go along with this at all.

    People are depressed because they lead depressing lives.

    So there are many women and men who would not want to have a child. Is this mental illness, a cause for therapy? No, of course not.

    There are many women and men who will have a child and be very unhappy. Is this a mental illness, or a cause for therapy. I say, absolutely not. But we do need to look at what is going on and protect the child absolutely, while trying to correct what problems we can in the people’s affairs.

    And then, and this is I think emblematic of the middle-class, there are people who will deliberately make sure that they have a child, and then be very unhappy. Mental Illness, cause for therapy, no of course not. We have to treat it just like in the situation above.

    What causes this is the marketing of parenthood, the sentimentalization and romanticiztion, and the selling of the pedagogy manuals.

    We need to organize and fight against Psychotherapy, Psychiatry, Recovery, and Life Coaching.

    People need political consciousness raising, and to become in touch with their feelings and to be able to live Authentic Lives. And I have to say that I believe that Simone de Beauvoir was correct in saying that, “For most women maternity is an inauthentic choice.”

    Please Join:
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    Nomadic

    • As I said, “PPD” is an invention like any other diagnosis. Most “PPD” is caused by high levels of stress – loss of income, deteriorated body image, interrupted sex life, changes in relationship due to change in status to “mother,” loss of friendships, increased isolation, loss of sleep, and on and on. Not to mention that a huge percentage of domestic abuse starts during pregnancy or right after birth. To suggest that “postpartum depression” is a disease state is rank ignorance or else intentional greed and manipulation. As I stated above, there are cultures where “PPD” DOES NOT HAPPEN AT ALL. If it is “biological,” why is it so much more common in modern industrial societies and so rare in tribal cultures?

  8. And so is psychotherapy the best way to respond to this invented condition known as PPD?

    It could not be, as learning to live within ones own skin and face up to one’s choices are what is required, and that will always mean striking back against injustice and abusers. People stay in denial because they don’t want to have to act.

    Psychotherapy always promotes denial, learning how to be “happy” without striking back.

    We must have our own anti-Mental Health, anti-Recovery Forum

    http://freedomtoexpress.freeforums.org/index.php

    Nomadic