PREPP: Preventing Postpartum Depression

Study Overview
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Brief Summary
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The primary aim of this study is to determine if a behavioral intervention targeting maternal caregiving of young infants can increase infant sleep and reduce fuss/cry behavior, and thereby (1) reduce the incidence and/or severity of postpartum maternal depression and (2) improve the quality of the mother-infant interaction and subsequent child development. Specifically, the study team will investigate: (1) the effectiveness of the intervention compared to usual care; (2) if the effects of the intervention can be detected in the assessments of the quality of mother-infant interaction; (3) if there are prenatal and/or postnatal biomarkers that can help identify infants whose behavior is more likely to play a role in their mothers' depression; (4) if these markers differentiate which infants will be most responsive to the intervention(s); and (5), if assessments of brain function at birth and at 4-6 weeks of age provide biological nodal points for identifying the effects of the intervention on infant brain development. Participants will be recruited during their 2nd trimester, and will be randomly separated into one of two groups: a group that receives coaching in parenting techniques (4 in-person coaching sessions and 1 phone session) or one that receives treatment as usual.

Detailed Description
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Of the nearly 4 million mothers delivering live births each year in the United States, approximately 560,000 - or 14% - will develop major or minor depression within the first four months postpartum, when the rate peaks. This number dwarfs prevalence rates for gestational diabetes (2-5%) and is comparable to preterm birth (11.4%). Postpartum depression (PPD) has substantial consequences: poorer maternal quality of life, significant emotional suffering, and suicide risk. PPD predicts diminished mother-infant bonding, and poor outcomes in social-emotional and, in some groups, cognitive development. PPD is undertreated in part because women are reluctant to seek treatment due to the stigma associated with mental health care, logistical barriers to at-tending added health care appointments, and disinclination to take medications while breastfeeding. Of preventive interventions, few embed services in obstetrical care or leverage the unique mother-infant dyadic orientation of the childbearing period. The investigators developed a novel intervention based on the conceptualization of maternal depression as a potential disorder of the mother-infant dyad, and one that can be approached through psychological and behavioral changes in the mother - commencing before birth - that affect her and the child. PREPP (Practical Resources for Effective Postpartum Parenting) enrolls distressed pregnant women at risk for PPD, spans late pregnancy to the 6 week postpartum check up, comprises four in-person 'coaching' sessions adjunctive to obstetrical (OB) prenatal and postnatal appointments, one phone session, and imparts (a) mindfulness and self-reflection skills, (b) parenting skills, and (c) psycho-education. The primary aim of this study is to determine if a behavioral intervention targeting maternal caregiving of young infants can increase infant sleep and reduce fuss/cry behavior, and thereby (1) reduce the incidence and/or severity of postpartum maternal depression and (2) improve the quality of the mother-infant interaction and subsequent child development.

Official Title
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Preventing Postpartum Depression: A Dyadic Approach Adjunctive to Obstetric Care

Conditions
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Postpartum Depression

Intervention / Treatment
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* Behavioral: Practical Resources for Effective Postpartum Parenting
* Behavioral: Enhanced Treatment As Usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy pregnant women between 18-45 years old (based on self report) A score of ≥21 on the Predictive Index of Postnatal Depression (PIPD), indicating risk for developing postpartum depression A healthy, singleton pregnancy (based on self report) English speaking (based on self report) Receiving standard prenatal care (based on self report) Exclusion Criteria: Multi-fetal pregnancy (based on self-report) Smoking, illicit drug use, or alcohol use during pregnancy (based on self-report) Acute medical illness or significant pregnancy complication (based on self-report) Currently in weekly, individual psychotherapy, including psychopharmacology (based on self report) Psychotic d/o; Bipolar I; Major Depressive d/o (based on M.I.N.I.)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Two groups: One receives PREPP prevention intervention and the other group receives Enhanced Treatment as Usual (psychoeducation about Postpartum Depression, referral and monitoring)
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Practical Resources for Effective Postpartum (PREPP)<br>A psychotherapeutic preventive intervention that involves psychoeducation and cognitive behavioral techniques. | Behavioral: Practical Resources for Effective Postpartum Parenting<br>* A preventive psychotherapy intervention for Postpartum Depression<br>* Other names: PREPP;|
| Active Comparator: Enhanced Treatment as Usual<br>Psychoeducation about Postpartum Depression, referral to treatment in the community and monitoring | Behavioral: Enhanced Treatment As Usual<br>* Psychoeducation about Postpartum Depression, referral to treatment in the community, clinical monitoring<br>* Other names: ETAU;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postpartum Depression Symptoms | Postpartum Depression Symptoms measured by Edinburgh Postnatal Depression Scale | 6-16 weeks postpartum | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improved Sleep | Improved self-report of sleep quality on Pittsburgh Sleep Quality Index and improved sleep shown on actigraphy monitor | 3rd trimester of pregnancy - 16 weeks postpartum | 
| Infant Behavior | Cry behavior and sleep behavior measured by The Baby Day Diary | 6 & 16 weeks postpartum | 
| Greater infant left frontal EEG power reflecting sleep spindle activity | More positive perceptions and objective assessments of maternal postpartum sleep efficiency will be mediated by greater infant left frontal EEG power reflecting sleep spindle activity and associated longer average durations of infant nocturnal sleep per maternal report and actigraphy. | Newborn-6 weeks postpartum | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Postpartum Depression Treatment