Researchers Explore Preventive Options for Perinatal Depression

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Many women have heard warnings and stories about postpartum depression, a serious mental illness, but not all women realize that depression can hit at any stage of pregnancy. Perinatal depression can occur during pregnancy or up to a year after childbirth, and Northwestern researchers are looking into new ways to prevent and treat this serious illness.

According to Melissa Simon, the vice chair for clinical research in Feinberg School of Medicine’s Department of Obstetrics and Gynecology, one in seven women experience perinatal depression, making it one of the most common pregnancy complications. Perinatal depression is diagnosed when the depressive episode lasts two weeks or longer, and symptoms include fatigue, changes in sleeping patterns, different eating habits, feelings of hopelessness and suicidal thoughts. It can ruin what should be a happy and exciting time in a new mother’s life, and Northwestern researchers are now looking into new ways to prevent and treat this debilitating mental illness.

Simon, an obstetrician, is part of a United States Preventative Service Task Force tackling perinatal depression. The group recently announced their recommendation that doctors help women seek counseling if they are at an increased risk of perinatal depression. Risks for perinatal depression include personal or family history of depression, a history of sexual abuse, current stressful life events, having an unplanned pregnancy, gestational diabetes, and low socioeconomic status.

Research studies have found counseling interventions to be the most effective at preventing perinatal depression. However, Simon says that there are more opportunities for further study.

Current research has focused on preventing perinatal depression on high risk women, but Simon said one research goal could be testing whether counseling helps prevent perinatal depression in the much larger group of women with only one or no risk factors for depression.

Previous research has found two therapies to be most effective at preventing perinatal depression: interpersonal behavioral therapy and cognitive behavioral therapy. Interpersonal behavioral therapy works to improve a person’s interpersonal relationships as a way to reduce stress. For example, it may address issues such as social isolation. Cognitive behavioral therapy involves challenging and changing dysfunctional emotions and behaviors.

Simon hopes to see even more research on these two therapies for perinatal depression prevention.

“They were provided to those at the highest risk for perinatal, not necessarily low risk,” she said. “We don’t know if those interventions would help women at low risk to prevent perinatal depression as well.”

Simon thinks researchers should study other potential preventive solutions, such as physical activity, dietary supplements, peer counseling, in-hospital postpartum education on infant care, and infant sleep education. Considering other solutions might help experts learn more about how to prevent perinatal depression.

She also wants to see better screening tools to help doctors identify patients who may need preventative care.

For now, one option for pregnant women is Mothers and Babies, a project championed by Darius Tandon, the project investigator and an associate professor at Feinberg. It is currently offered in 21 states through clinics, nonprofits and childcare centers.

The task force’s recommendations cited Mothers and Babies as one of the more successful preventive programs available. It uses group therapy sessions both during and after pregnancy. In the group sessions, cognitive behavioral therapy modules focus on mood and health, the effects of stress, the importance of rewarding activities, positive mother-child attachment, parenting strategies, and how to reduce distorted and automatic, negative thoughts. Individual therapy is offered as well.

Tandon said the increased social connections from group therapy help make Mothers and Babies beneficial.

“By meeting and interacting with other women who are pregnant or have just delivered, we are able
to establish connections among women who may never have connected otherwise,” he said. “The group modality also normalizes the stressors experienced by women and allows group members to share strategies for managing stress that can be used by other group members.”

Tandon is currently developing and studying a Fathers and Babies program, which is pilot testing and would be delivered to the male partners of women receiving Mothers and Babies counseling. Tandon also wants to continue exploring and expanding Mother and Babies, and hopes to pursue future studies that look into the long-term effects Mother and Babies has on parenting and child development.

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