A pilot postpartum depression intervention in rural Indiana: Recruitment barriers, retention, and implementation lessons

Rural postpartum women face substantial barriers to evidence-based treatment for postpartum depression (PPD). The purpose of this study was to evaluate recruitment, retention, intervention delivery, and acceptability of a four-session, group-based pilot intervention adapted for rural Indiana. An open pilot feasibility study was conducted at two rural health systems. Feasibility outcomes were compared with prespecified recruitment and retention thresholds; acceptability and participant symptom scores were summarized descriptively. Among 52 eligible women, five enrolled (9.6%) and two initiated and completed all four sessions, yielding 40.0% retention among enrollees. Prespecified recruitment (25%) and retention (60%) thresholds were not met. Among the two completers, intervention fidelity and session attendance were 100%, and participant and facilitator acceptability ratings were high. Depression scores decreased for both participants over time; however, the sample was insufficient to evaluate intervention efficacy. The tested recruitment and group-delivery model was not feasible in these settings. Findings identify barriers and design modifications needed before a larger trial, including earlier and repeated recruitment, flexible delivery options, and stronger linkage between screening and treatment initiation.