Behavioral Change in the Mother-Infant Dyad: Preventing Postpartum Depression
Condition: Postpartum Depression
MeSH terms: Depression, Postpartum; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Postpartum depression (PPD) is undertreated and the consequences of this are substantial for
      women and children. Studies show that infant cry/fuss and sleep behavior are associated with
      PPD, and that parenting interventions can change infant behavior, yet these findings have
      never been applied to PPD. In this study, the investigators are teaching parenting skills to
      increase infant nocturnal sleep and reduce fuss/cry behavior to women likely to develop PPD
      to see if the investigators can prevent the onset of this disorder.
    

Detailed description: 
      Of the over 4 million live births each year in the United States, nearly 800,000 - or 20% -
      of the mothers will develop major or minor depression within the first 3 months postpartum.
      This number dwarfs prevalence rates for gestational diabetes (2-5%) and preterm birth
      (12.7%). Existing clinical approaches to postpartum depression (PPD) use standard
      pharmacologic and psychological interventions to reduce women's symptoms. Nevertheless, PPD
      is undertreated, in part because women are reluctant to seek treatment due to stigma
      associated with mental health care and disinclination to take psychotropic medications when
      breastfeeding. The consequences of this are substantial. Untreated PPD is associated with
      diminished quality of life and significant emotional suffering for women, and, through
      compromised caregiving, poor outcomes in children's cognitive and social-emotional
      development. Although maternal risk factors for PPD are well known, protocols for prevention
      based on commonly used depression interventions are only beginning to be evaluated. Building
      on developmental data showing the profound bi-directionality of emotional and behavioral
      influences between mother and infant, the investigators are testing a novel PPD intervention
      protocol that challenges the standard, individually-focused treatment paradigm. Our
      intervention is based on the conceptualization of PPD as a potential disorder of the dyad,
      and one that can be approached through behavioral change in and affective engagement with
      mother and child. Studies show that infant cry/fuss and sleep behavior are associated with
      PPD, and that parenting interventions can change infant behavior, yet these findings have
      never been applied to PPD. The investigators aim to collect data on a novel PPD risk-reducing
      protocol based on a dyadic behavioral approach to PPD in which the investigators treat
      at-risk women by promoting maternally-mediated behavioral changes in their infants. The
      investigators will select a sample of pregnant women at risk for PPD, teach parenting skills
      to increase infant nocturnal sleep and reduce fuss/cry behavior to half of the sample during
      3 perinatal visits, then evaluate infant behavior at 6 and 14 weeks, and maternal mood at 6,
      10, and 14 weeks postpartum. The investigators will fully exploit the investigative
      opportunities of this intervention study by using state-of-the-art EEG and fetal monitoring
      to characterize early biomarkers associated with infant behavior and behavior change. This
      study has the potential to have a major impact on clinical research, and to transform the
      standard care of PPD in that (1) the intervention will have high rates of treatment
      compliance because (a) the protocol sessions can be incorporated into usual perinatal medical
      visits, (b) parenting skills will appeal to women as a non-psychiatric intervention, (c) the
      clinical approach will have face validity given the dyadic focus of the perinatal period; (2)
      its aim is prevention; (3) it fosters both maternal and child well being; (4) it will expand
      the risk factors for PPD to include neurobehavioral markers in the perinate.
    

Intervention name(s): Behavioral Intervention for PPD
Intervention type(s): Behavioral
Intervention description(s): We will select a sample of pregnant women at risk for PPD, teach parenting skills to increase infant nocturnal sleep and reduce fuss/cry behavior to half of the sample during 3 perinatal visits.
Other intervention name(s): Preventative Behavioral Intervention for PPD.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: prevention; postpartum depression