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ABSTRACT: BACKGROUND: Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors. METHOD: Ninety-five mother-child dyads (children ages 7-18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers' parenting. RESULTS: Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors. CONCLUSIONS: When treating psychiatrically ill children, it is important for a child's clinician to consider mothers' childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting.
Depression and Anxiety 05/2013; · 4.18 Impact Factor
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The Journal of Clinical Psychiatry 12/2012; 73(12):1563-5. · 5.80 Impact Factor
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ABSTRACT: Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure.
Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included ≥ 18 years, >12 on the Edinburgh Postnatal Depression Scale, 10-32 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems.
Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure.
Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.
Depression and Anxiety 03/2012; 29(7):563-73. · 4.18 Impact Factor
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ABSTRACT: The differential roles of psychotherapy and pharmacotherapy in the management of bipolar (BP) II depression are unknown. As a first step toward exploring this issue, we conducted a pilot study to evaluate the feasibility and acceptability of comparing a BP-specific psychotherapy [Interpersonal and Social Rhythm Therapy (IPSRT)] to quetiapine as treatments for BP-II depression.
Unmedicated individuals (n = 25) meeting DSM-IV criteria for BP-II disorder, currently depressed, were randomly assigned to weekly sessions of IPSRT (n = 14) or quetiapine (n = 11), flexibly dosed from 25-300 mg. Participants were assessed with weekly measures of mood and followed for 12 weeks. Treatment preference was queried prior to randomization.
Using mixed effects models, both groups showed significant declines in the 25-item Hamilton Rating Scale for Depression [F(1,21) = 44, p < 0.0001] and Young Mania Rating Scale [F(1,21) = 20, p = 0.0002] scores over time but no group-by-time interactions. Dropout rates were 21% (n = 3) and 27% (n = 3) in the IPSRT and quetiapine groups, respectively. Overall response rates (defined as ≥ 50% reduction in depression scores without an increase in mania scores) were 29% (n = 4) in the IPSRT group and 27% (n = 3) in the quetiapine group. Measures of treatment satisfaction were high in both groups. Treatment preference was not associated with outcomes.
Outcomes in participants with BP-II depression assigned to IPSRT monotherapy or quetiapine did not differ over 12 weeks in this small study. Follow-up trials should examine characteristics that predict differential response to psychotherapy and pharmacotherapy.
Bipolar Disorders 03/2012; 14(2):211-6. · 5.29 Impact Factor
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Holly A Swartz,
Ellen Frank,
Kelly O'Toole,
Nathan Newman,
Helen Kiderman,
Scott Carlson,
Janis W Fink,
Yu Cheng,
Catherine C Maihoefer,
Kelly Forster Wells,
Patricia R Houck,
Tiffany Painter,
Sara H Ortenzio,
Stacy L Simon,
Perry Henschke,
Frank Ghinassi
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ABSTRACT: Interpersonal and social rhythm therapy (IPSRT) is an evidence-based psychotherapy for mood disorders. The goal of this quality improvement initiative was to demonstrate feasibility of implementing IPSRT across the continuum of outpatient and inpatient care within an academic medical center.
A multidisciplinary work group was convened to implement IPSRT in outpatient (N=48), inpatient (N=602), and intensive outpatient (N=68) programs of an academic medical center. Quality improvement performance markers (including symptoms and group attendance rates) were collected.
Institutional preference for group treatments required adaptation of IPSRT from an individual to group psychotherapy format. Iterative problem solving and protocol development resulted in models of group IPSRT appropriate for each level of care. Performance outcome markers were favorable, indicating feasibility of implementation.
At a single, multisite, urban, academic medical center, IPSRT proved a feasible evidence-based psychotherapy for implementation across levels of care in routine practice.
Psychiatric services (Washington, D.C.) 11/2011; 62(11):1377-80. · 2.81 Impact Factor
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ABSTRACT: Individuals with depression and low social support are at elevated risk for developing cardiovascular disease--presumptively through mechanisms involving dysregulated stress physiology. While depressed individuals often report diminished social support and elevated levels of social distress, few studies have examined how social factors impact stress-related cardiovascular activity in depressed samples. Accordingly, we evaluated the social modulation of stress-related cardiovascular activity in a sample of 38 medically healthy, unmedicated depressed and nondepressed individuals.
Cardiovascular and psychological measures were obtained before and after depressed and nondepressed women engaged in a speech stress task. To evaluate the impact of social factors on stress responses, half of the women completed the speech stress task first, while the other half completed the speech stress after engaging in a relationship-focused imagery task.
Nondepressed women who first thought about a close relationship displayed global attenuations in blood pressure throughout the subsequent stress task, consistent with a stress-buffering effect of perceived social support. Conversely, depressed women who first thought about a close relationship displayed global elevations in blood pressure throughout the subsequent stress task, consistent with a stress-enhancing effect of perceived social distress in depressed women.
Thinking about a close relationship differentially impacted subsequent cardiovascular activity during an evocative stressor in depressed and nondepressed women. Understanding the social context in which stress is experienced may aid in identifying, and ultimately attenuating, cardiovascular risks observed among patients with major depressive disorder.
Health Psychology 05/2011; 30(3):276-84. · 3.87 Impact Factor
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ABSTRACT: Bipolar II disorder is a common, recurrent, and disabling psychiatric illness, and yet little is known about how best to treat it. The pressing clinical need for evidence-based approaches to the treatment of bipolar II disorder, coupled with recent publication of pertinent studies, calls for an updated review of this literature. This review focuses on a critical examination of the evidence supporting the efficacy of treatments for acute depressive episodes in bipolar II disorder.
A MEDLINE (via Ovid) search of journals, covering the period from January 1950 to January 2009, was performed to identify relevant studies. Keywords used were bipolar II disorder, bipolar disorder, bipolar depression, and pharmacotherapy. Studies were further limited to those that were in adult samples, published in peer-reviewed journals, and written in English.
We examined all randomized trials evaluating the use of pharmacotherapy in the treatment of acute bipolar II depression. Studies with mixed samples of bipolar I and II or bipolar II and unipolar depression were examined as well. Twenty-one randomized trials were identified and reviewed.
Therapeutic agents were rated according to the quality of evidence supporting their efficacy as treatments for bipolar II depression.
Ninety percent of relevant trials were published after 2005. Quetiapine was judged as having compelling evidence supporting its efficacy. Lithium, antidepressants, and pramipexole were judged as having preliminary support for efficacy. Lamotrigine was considered to have mixed support.
Although progress has been made, further research on bipolar II depression is warranted.
The Journal of Clinical Psychiatry 03/2011; 72(3):356-66. · 5.80 Impact Factor
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ABSTRACT: To evaluate the impact of acute stress and relationship-focused imagery on cardiac vagal control, as indicated by levels of respiratory sinus arrhythmia (RSA), in depressed and nondepressed women. Impairment in cardiac parasympathetic (vagal) control may confer risk for cardiac mortality in depressed populations.
Electrocardiogram and respiratory rate were evaluated in 15 nonmedicated depressed women and 15 matched controls during two laboratory conditions: 1) a relationship-focused imagery designed to elicit vagal activation; and 2) a speech stressor designed to evoke vagal withdrawal.
As expected, the relationship-focused imagery increased RSA (F(3,66) = 3.79, p = .02) and the speech stressor decreased RSA (F(3,66) = 4.36, p = .02) across women. Depressed women exhibited lower RSA during the relationship-focused imagery, and this effect remained after control for respiratory rate and trauma history (F(1,21) = 5.65, p = .027). Depressed women with a trauma history exhibited the lowest RSA during the stress condition (F(1,22) = 9.61, p = .05). However, after controlling for respiratory rate, Trauma History × Task Order (p = .02) but not Trauma History × Depression Group (p = .12) accounted for RSA variation during the stress condition.
Depression in women is associated with lower RSA, particularly when women reflect on a close love relationship, a context expected to elicit vagal activation and hence increase RSA. In contrast, depression-related variation in stressor-evoked vagal activity seems to covary with women's trauma history. Associations between vagal activity and depression are complex and should be considered in view of the experimental conditions under which vagal control is assessed, as well as physiological and behavioral factors that may affect vagal function.
Psychosomatic Medicine 03/2011; 73(4):336-43. · 3.97 Impact Factor
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08/2010: pages 430 - 442; , ISBN: 9780470661277
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ABSTRACT: The prevalence of suicide attempts (SA) in bipolar II disorder (BPII), particularly in comparison to the prevalence in bipolar I disorder (BPI), is an understudied and controversial issue with mixed results. To date, there has been no comprehensive review of the published prevalence data for attempted suicide in BPII.
We conducted a literature review and meta-analysis of published reports that specified the proportion of individuals with BPII in their presentation of SA data. Systematic searching yielded 24 reports providing rates of SA in BPII and 21 reports including rates of SA in both BPI and BPII. We estimated the prevalence of SA in BPII by combining data across reports of similar designs. To compare rates of SA in BPII and BPI, we calculated a pooled odds ratio (OR) and 95% confidence interval (CI) with random-effect meta-analytic techniques with retrospective data from 15 reports that detailed rates of SA in both BPI and BPII.
Among the 24 reports with any BPII data, 32.4% (356/1099) of individuals retrospectively reported a lifetime history of SA, 19.8% (93/469) prospectively reported attempted suicide, and 20.5% (55/268) of index attempters were diagnosed with BPII. In 15 retrospective studies suitable for meta-analysis, the prevalence of attempted suicide in BPII and BPI was not significantly different: 32.4% and 36.3%, respectively (OR = 1.21, 95% CI: 0.98-1.48, p = 0.07).
The contribution of BPII to suicidal behavior is considerable. Our findings suggest that there is no significant effect of bipolar subtype on rate of SA. Our findings are particularly alarming in concert with other evidence, including (i) the well-documented predictive role of SA for completed suicide and (ii) the evidence suggesting that individuals with BPII use significantly more violent and lethal methods than do individuals with BPI. To reduce suicide-related morbidity and mortality, routine clinical care for BPII must include ongoing risk assessment and interventions targeted at risk factors.
Bipolar Disorders 02/2010; 12(1):1-9. · 5.29 Impact Factor
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David J Kupfer,
David A Axelson,
Boris Birmaher,
Charlotte Brown,
David E Curet,
Andrea Fagiolini,
Ellen Frank,
Edward S Friedman,
Victoria J Grochocinski,
Patricia R Houck,
Amy M Kilbourne,
Benoit H Mulsant,
Bruce G Pollock,
Charles F Reynolds,
Mary G Stofko, Holly A Swartz,
Michael E Thase,
Scott R Turkin,
Ellen M Whyte
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ABSTRACT: Adolescents, elderly persons, African Americans, and rural residents with bipolar disorder are less likely than their middle-aged, white, urban counterparts to be diagnosed, receive adequate treatment, remain in treatment once identified, and have positive outcomes. The Bipolar Disorder Center for Pennsylvanians (BDCP) study was designed to address these disparities. This report highlights the methods used to recruit, screen, and enroll a cohort of difficult-to-recruit individuals with bipolar disorder.
Study sites included three specialty clinics for bipolar disorder in a university setting and a rural behavioral health clinic. Study operations were standardized, and all study personnel were trained in study procedures. Several strategies were used for recruitment.
It was possible to introduce the identical assessment and screening protocol in settings regardless of whether they had a history of implementing research protocols. This protocol was also able to be used across the age spectrum, in urban and rural areas, and in a racially diverse cohort of participants. Across the four sites 515 individuals with bipolar disorder were enrolled as a result of these methods (69 African Americans and 446 non-African Americans). Although clinical characteristics at study entry did not differ appreciably between African Americans and non-African Americans, the pathways into treatment differed significantly.
Rigorous recruitment and assessment procedures can be successfully introduced in different settings and with different patient cohorts, thus facilitating access to high-quality treatment for individuals who frequently do not receive appropriate care for bipolar disorder.
Psychiatric services (Washington, D.C.) 08/2009; 60(7):888-97. · 2.81 Impact Factor
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ABSTRACT: We conducted a proof of concept study to determine the feasibility of using an individual psychotherapy, Interpersonal and Social Rhythm Therapy (IPSRT), as monotherapy for the acute treatment of bipolar II depression.
Unmedicated individuals (n = 17) meeting DSM-IV criteria for bipolar II disorder and currently depressed received weekly psychotherapy (IPSRT) for 12 weeks. After 12 weeks of acute treatment, individuals received an additional 8 weeks of follow-up treatment consisting of continued weekly IPSRT with supplementary lamotrogine for IPSRT non-responders.
By week 12, 41% (n = 7) of the sample responded to IPSRT monotherapy (defined as > or =50% reduction in depression scores without an increase in mania scores), 41% (n = 7) dropped out of or were removed from the study, and 18% (n = 3) did not respond to treatment. By week 20, 53% (n = 9) had achieved a response and 29% (n = 5) achieved a full remission of symptoms.
Interpersonal and Social Rhythm Therapy appears to be a promising intervention for a subset of individuals with bipolar II depression. A randomized controlled trial is needed to systematically evaluate the efficacy of IPSRT as an acute monotherapy for bipolar II depression.
Bipolar Disorders 03/2009; 11(1):89-94. · 5.29 Impact Factor
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ABSTRACT: Depression during pregnancy is one of the strongest predictors of postpartum depression, which, in turn, has deleterious, lasting effects on infant and child well-being and on the mother's and father's mental health. The primary question guiding this randomized controlled trial was, Does culturally relevant, enhanced brief interpersonal psychotherapy (IPT-B) confer greater advantages to low-income, pregnant women than those that accrue from enhanced usual care in treating depression in this population? Enhanced IPT-B is a multicomponent model of care designed to treat antenatal depression and consists of an engagement session, followed by eight acute IPT-B sessions before the birth and maintenance IPT up to six months postpartum. IPT-B was specifically enhanced to make it culturally relevant to socioeconomically disadvantaged women.
Fifty-three non-treatment-seeking, pregnant African-American and white patients receiving prenatal services in a large, urban obstetrics and gynecology clinic and meeting criteria for depression on the Edinburgh Postnatal Depression Scale (score >12 on a scale of 0 to 30) were randomly assigned to receive either enhanced IPT-B (N=25) or enhanced usual care (N=28), both of which were delivered in the clinic. Participants were assessed before and after treatment on depression diagnoses, depressive symptoms, and social functioning.
Intent-to-treat analyses showed that participants in enhanced IPT-B, compared with those in enhanced usual care, displayed significant reductions in depression diagnoses and depressive symptoms before childbirth (three months postbaseline) and at six months postpartum and showed significant improvements in social functioning at six months postpartum.
Findings suggest that enhanced IPT-B ameliorates depression during pregnancy and prevents depressive relapse and improves social functioning up to six months postpartum.
Psychiatric services (Washington, D.C.) 03/2009; 60(3):313-21. · 2.81 Impact Factor
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ABSTRACT: Recent studies demonstrate the poor psychosocial outcomes associated with bipolar disorder. Occupational functioning, a key indicator of psychosocial disability, is often severely affected by the disorder. The authors describe the effect of acute treatment with interpersonal and social rhythm therapy on occupational functioning over a period of approximately 2.5 years.
Patients with bipolar I disorder were randomly assigned to receive either acute and maintenance interpersonal and social rhythm therapy, acute and maintenance intensive clinical management, acute interpersonal and social rhythm therapy and maintenance intensive clinical management, or acute intensive clinical management and maintenance interpersonal and social rhythm therapy, all with appropriate pharmacotherapy. Occupational functioning was measured with the UCLA Social Attainment Scale at baseline, at the end of acute treatment, and after 1 and 2 years of maintenance treatment.
The main effect of treatment did not reach conventional levels of statistical significance; however, the authors observed a significant time by initial treatment interaction. Participants initially assigned to interpersonal and social rhythm therapy showed more rapid improvement in occupational functioning than those initially assigned to intensive clinical management, primarily accounted for by greater improvement in occupational functioning during the acute treatment phase. At the end of 2 years of maintenance treatment, there were no differences between the treatment groups. A gender effect was also observed, with women who initially received interpersonal and social rhythm therapy showing more marked and rapid improvement. There was no effect of maintenance treatment assignment on occupational functioning outcomes.
In this study, interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no such emphasis on functional capacities.
American Journal of Psychiatry 11/2008; 165(12):1559-65. · 12.54 Impact Factor
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ABSTRACT: Impairment in maternal interpersonal function represents a risk factor for poor psychiatric outcomes among children of depressed mothers. However, the mechanisms by which this effect occurs have yet to be fully elucidated. Elevated levels of emotional or physiological reactivity to interpersonal stress may impact depressed mothers' ability to effectively negotiate child-focused conflicts. This effect may become particularly pronounced when depressed mothers are parenting a psychiatrically ill child.
The current feasibility study evaluated mothers' emotional and cardiovascular reactivity in response to an acute, child-focused stress task. Twenty-two depressed mothers of psychiatrically ill children were recruited from a larger clinical trial; half were randomly assigned to receive an adapted form of interpersonal psychotherapy (IPT-MOMS), while the other half received treatment as usual (TAU). For comparison purposes, a matched sample of 22 nondepressed mothers of psychiatrically healthy children was also evaluated.
Depressed mothers receiving minimal-treatment TAU displayed the greatest increases in depressed mood, heart rate, and diastolic blood pressure in response to the child-focused stress task, and significantly differed from the relatively low levels of reactivity observed among nondepressed mothers of healthy children. In contrast, depressed mothers receiving IPT-MOMS displayed patterns of reactivity that fell between these extreme groups. Maternal stress reactivity was associated not only with maternal psychiatric symptoms, but also with levels of chronic parental stress and maternal history of childhood emotional abuse.
Future, more definitive research is needed to evaluate depressed mothers' interpersonal stress reactivity, its amenability to treatment, and its long-term impact on child psychiatric outcomes.
Depression and Anxiety 10/2008; 26(2):110-6. · 4.18 Impact Factor
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ABSTRACT: Whether or not to use antidepressants in patients with bipolar disorder is a matter of debate. Antidepressant treatment of bipolar depression has been associated with manic switch and cycle acceleration. Furthermore, recent studies have argued against the efficacy of antidepressants in the treatment of bipolar depression. Nevertheless, many clinicians continue to employ antidepressants, especially in the management of severe depression that is unresponsive to mood stabilizers alone.
Because of the unclear risk-to-benefit ratio of antidepressants in bipolar disorder, we have performed an updated review of the relevant literature. In this article we examine (1) all randomized controlled trials (RCTs) evaluating the use of antidepressants in the treatment of acute bipolar depression and assessing the risk of antidepressant-induced manic switch and (2) non-RCT trials that evaluate the impact of antidepressant discontinuation after acute antidepressant response.
A MEDLINE search of journals, covering the period from January 1966 to July 2007 and supplemented by bibliographic cross-referencing, was performed to identify the relevant studies. The keywords used were antidepressant, bipolar depression, bipolar disorder, switch, manic switch, antidepressant-induced mania, predictors, and antidepressant discontinuation. Criteria used to select studies included (1) English language and (2) studies published in peer-reviewed journals.
Randomized, double-blind, placebo-controlled studies have demonstrated that antidepressants exert some efficacy in the treatment of bipolar depression in some populations of patients. Moreover, the risk of manic switch, although not totally countered, appears to be strongly reduced when antidepressants are given in combination with a mood stabilizer and when new-generation antide-pressants are preferred over old tricyclic antidepressants. Finally, some studies have proven that the continuous use of antidepressants after the remission of a major depressive episode helps to prevent further depressive relapses without causing a significant increase in manic relapses.
Clearly, there is a place for antidepressants in bipolar disorder; however, it is important to be cautious and evaluate their use on a case-by-case basis. Looking at specific depressive symptoms might help physicians in making the choice of whether to prescribe or not prescribe antidepressants.
The Journal of Clinical Psychiatry 08/2008; 69(8):1307-18. · 5.80 Impact Factor
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ABSTRACT: Depressed mothers of children with psychiatric illness struggle with both their own psychiatric disorder and the demands of caring for ill children. When maternal depression remains untreated, mothers suffer, and psychiatric illness in their offspring is less likely to improve. This randomized, controlled trial compared the interpersonal psychotherapy for depressed mothers (IPT-MOMS), a nine-session intervention based on standard interpersonal psychotherapy, to treatment as usual for depressed mothers with psychiatrically ill offspring.
Forty-seven mothers meeting DSM-IV criteria for major depression were recruited from a pediatric mental health clinic where their school-age children were receiving psychiatric treatment and randomly assigned to IPT-MOMS (N=26) or treatment as usual (N=21). Mother-child pairs were assessed at three time points: baseline, 3-month follow-up, and 9-month follow-up. Child treatment was not determined by the study.
Compared to subjects assigned to treatment as usual, subjects assigned to IPT-MOMS showed significantly lower levels of depression symptoms, as measured by the Hamilton Depression Rating Scale, and higher levels of functioning, as measured by the Global Assessment of Functioning, at 3-month and 9-month follow-ups. Compared to the offspring of mothers receiving treatment as usual, the offspring of mothers assigned to IPT-MOMS showed significantly lower levels of depression as measured by the Children's Depressive Inventory at the 9-month follow-up.
Assignment to IPT-MOMS was associated with reduced levels of maternal symptoms and improved functioning at the 3- and 9-month follow-ups compared to treatment as usual. Maternal improvement preceded improvement in offspring, suggesting that maternal changes may mediate child outcomes.
American Journal of Psychiatry 07/2008; 165(9):1155-62. · 12.54 Impact Factor
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Holly A Swartz
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ABSTRACT: The tendency for patients with bipolar II disorder to present with depressive symptoms rather than hypomanic symptoms can lead to a misdiagnosis of unipolar depression. These patients are often treated with antidepressants, which may be inappropriate for patients with bipolar II disorder due to the risk of inducing manic switching or rapid cycling. Misdiagnosis and mistreatment or nontreatment can lead to substantial psychosocial dysfunction, which may be best addressed in the context of psychotherapy. Psychotherapy in conjunction with pharmacotherapy has been shown to be an effective treatment for patients with bipolar II disorder, but more research is needed to better understand how treatment interventions should be used to optimize symptomatic and functional outcomes.
The Journal of Clinical Psychiatry 06/2008; 69(5):e15. · 5.80 Impact Factor
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04/2008: pages 275 - 293; , ISBN: 9780470696385
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ABSTRACT: Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.
Journal of Contemporary Psychotherapy 03/2008; 38(1):23-33.
