MOMCare: Culturally Relevant Treatment Services for Perinatal Depression

University of Washington

Status: Completed

Conditions: Depression

Treatments: Behavioral: MOMCare

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01045655

R01MH084897 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The study will evaluate the effectiveness of a culturally relevant, multi-component intervention for antenatal depression. The intervention includes an engagement session, and the woman's choice of brief interpersonal psychotherapy and/or pharmacotherapy in a stepped care treatment for depression model.

Full description

The randomized control trial will evaluate the effects of a culturally relevant, multi-component intervention for antenatal depression. MOMCare has the potential to overcome patient, provider, and system-level barriers to care and engage depressed, low-income women in evidence-based treatments to reduce antenatal depressive symptoms, improve maternal psychosocial functioning, and ameliorate postpartum depression. Specific Aim 1: To evaluate the impact of MOMCare on treatment engagement and retention. Specific Aim 2: To evaluate the impact of MOMCare on maternal clinical symptoms and functional outcomes. Specific Aim 3: To conduct an incremental cost-effectiveness analysis for a health care and welfare agency perspective that includes a) tracking the medical costs of health service use in MOMCare and usual care patients; b) monitoring the use of infant preventative health services in both groups; and c) tracking the percentage of women on Medicaid and the percentage working in both groups.

The intervention will be assessed through a practical randomized controlled trial in which we have recruited 168 pregnant women with major depression and/or dysthymia who were on Medicaid and/or received Maternal Support Services (MSS) in selected public health centers in Seattle - King County (PHSKC). Patients who were eligible and consented to study enrollment were randomly assigned to either usual care (UC) or MOMCare. Baseline and four follow-up assessments (3 - 18 months post-baseline) are scheduled for study participants in both groups. The MOMCare intervention includes a choice of brief interpersonal psychotherapy or collaborative management of antidepressant medication. Treatment response will be monitored, and the treatment will be adjusted as necessary (adding treatments, increasing dosages).

Enrollment: 168 patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 or older
• pregnant: 12-32 weeks gestation
• able to speak English
• telephone access
• major depressive disorder or dysthymia
• on Medicaid
• receiving health care in King County, Washington

Exclusion criteria

• currently in psychotherapy
• currently receiving pharmacotherapy from a psychiatrist
• high suicide risk
• history of bipolar disorder
• history of schizophrenia
• substance use or dependence in previous 3 months
• currently in a relationship with severe interpersonal violence
• history of repetitive self-harm behavior

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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168 participants in 2 patient groups

MOMCare intervention

Experimental group

Description:

Depression care treatment with study depression care specialist (brief interpersonal psychotherapy or pharmacotherapy)

Treatment:

Behavioral: MOMCare

Care Plus

No Intervention group

Description:

Usual care group; referral to community mental health treatment