Effectiveness of two systems-level interventions to address perinatal depression in obstetric settings (PRISM): an
Nancy Byatt1, Linda Brenckle2, Padma Sankaran2
1Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA.
Insights
Two interventions for perinatal depression, MCPAP for Moms and PRISM, showed similar effectiveness in reducing depression symptoms. MCPAP for Moms offers broader population reach with lower intensity.
Area of Science:
- Obstetrics and Gynecology
- Psychiatry
- Public Health
Background:
- Perinatal depression is a prevalent and undertreated condition with significant adverse outcomes for mothers and infants.
- Systems-level interventions in obstetric settings are crucial for managing perinatal depression.
- The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms and the PRogram In Support of Moms (PRISM) are two such interventions.
Purpose of the Study:
- To compare the effectiveness of MCPAP for Moms and PRISM interventions in improving depression symptoms among women with perinatal depression.
- To assess the impact of these interventions on participation in mental health treatment.
- To evaluate the systems-level approach to perinatal mental healthcare in obstetric settings.
Main Methods:
- A cluster-randomised, active-controlled trial involving obstetric practices in Massachusetts.
- Participants were English-speaking women aged 18 years or older screening positive for depression (EPDS score ≥10).
- Primary outcome was the change in depression symptoms (EPDS score) from baseline to 11-13 months postpartum, analyzed using intention-to-treat.
Main Results:
- 10 obstetric practices were randomized, with 312 women recruited (162 in MCPAP for Moms, 150 in PRISM).
- Both groups showed a clinically significant decrease in EPDS scores (4.2 for MCPAP for Moms, 4.3 for PRISM) from baseline to postpartum.
- No significant difference in depression symptom improvement was found between the MCPAP for Moms and PRISM groups (p=0.87).
Conclusions:
- MCPAP for Moms and PRISM interventions are equally effective in improving perinatal depression symptoms.
- The observed 4-point decrease in EPDS scores is clinically significant.
- MCPAP for Moms, with its lower intensity and population-based reach, presents a scalable option for widespread implementation.
Background:
Perinatal depression is a common and undertreated condition, with potential deleterious effects on maternal, obstetric, infant, and child outcomes. We aimed to compare the effectiveness of two systems-level interventions in the obstetric setting-the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms and the PRogram In Support of Moms (PRISM)-in improving depression symptoms and participation in mental health treatment among women with perinatal depression.
Methods:
In this cluster-randomised, active-controlled trial, obstetric practices across Massachusetts (USA) were allocated (1:1) via covariate adaptive randomisation to either continue participating in the MCPAP for Moms intervention, a state-wide, population-based programme, or to participate in the PRISM intervention, which involved MCPAP for Moms plus a proactive, multifaceted, obstetric practice-level intervention with intensive implementation support. English-speaking women (aged ≥18 years) who screened positive for depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥10) were recruited from the practices. Patients were followed up at 4-25 weeks of gestation, 32-40 weeks of gestation, 0-3 months postpartum, 5-7 months postpartum, and 11-13 months postpartum via telephone interview. Participants were masked to the intervention; investigators were not masked. The primary outcome was change in depression symptoms (EPDS score) between baseline assessment and 11-13 months postpartum. Analysis was done by intention to treat, fitting generalised linear mixed models adjusting for age, insurance status, education, and race, and accounting for clustering of patients within practices. This trial is registered with ClinicalTrials.gov, NCT02760004.
Findings:
Between July 29, 2015, and Sept 20, 2021, ten obstetric practices were recruited and retained; five (50%) practices were randomly allocated to MCPAP for Moms and five (50%) to PRISM. 1265 participants were assessed for eligibility and 312 (24·7%) were recruited, of whom 162 (51·9%) were enrolled in MCPAP for Moms practices and 150 (48·1%) in PRISM practices. Comparing baseline to 11-13 months postpartum, EPDS scores decreased by 4·2 (SD 5·2; p<0·0001) among participants in MCPAP for Moms practices and by 4·3 (SD 4.5; p<0·0001) among those in PRISM practices (estimated difference between groups 0·1 [95% CI -1·2 to 1·4]; p=0·87).
Interpretation:
Both the MCPAP for Moms and PRISM interventions were equally effective in improving depression symptoms. This finding is important because the 4-point decrease in EPDS score is clinically significant, and MCPAP for Moms has a lower intensity and greater population-based reach than does PRISM.
Funding:
US Centers for Disease Control and Prevention.
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