A Pragmatic Randomized Clinical Trial of Behavioral Activation for Depressed Pregnant Women

• Authors: Sona Dimidjian, University of Colorado Boulder; Sherryl H Goodman, Emory University; Nancy E. Sherwood, HealthPartners Institute for Education & Research; Greg E Simon, Group Health Cooperative; Evette Ludman, Group Health Cooperative; Robert Gallop, West Chester University; Stacy Shaw Welch, Evidence-based Treatment Centers of Seattle; Jennifer M. Boggs, Kaiser Permanente Colorado Institute for Health Research; Christina A. Metcalf, University of Colorado Boulder; Sam Hubley, University of Colorado School of Medicine; J. David Powers, Kaiser Permanente Colorado Institute for Health Research; Arne Beck, Kaiser Permanente Colorado Institute for Health Research
• Journal Title: Journal of Consulting and Clinical Psychology
• Volume: Volume 85, Number 1
• Publisher: American Psychological Association | 2017-01-01, Pages 26-36
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1037/ccp0000151
• Subjects: Psychology, Clinical; Health Sciences, Obstetrics and Gynecology; Health Sciences, Epidemiology
• Keywords: Social Sciences; Psychology, Clinical; Psychology; depression; behavioral activation; pregnancy; postpartum; randomized controlled trial; ANTIDEPRESSANT MEDICATION; COGNITIVE THERAPY; DECISION-MAKING; METAANALYSIS; SEVERITY; ANXIETY; ADULTS; PSYCHOTHERAPY; PREFERENCES; RECURRENCE

Abstract

Objective: Depression among pregnant women is a prevalent public health problem associated with poor maternal and offspring development. Behavioral activation (BA) is a scalable intervention aligned with pregnant women's preference for nonpharmacological depression care. This is the first test of the effectiveness of BA for depression among pregnant women, which aimed to evaluate the effectiveness of BA as compared with treatment as usual (TAU). Method: Pregnant women (mean age = 28.75 years; SD = 5.67) with depression symptoms were randomly assigned to BA (n = 86) or TAU (n = 77). Exclusion criteria included known bipolar or psychotic disorder or immediate self-harm risk. Follow-up assessment occurred 5 and 10 weeks postrandomization and 3 months postpartum using self-report measures of primary and secondary outcomes and putative targets. Results: Compared with TAU, BA was associated with significantly lower depressive symptoms (d = 0.34, p =.04) and higher remission (56.3% vs. 30.3%, p =.003). BA also demonstrated significant advantage on anxiety and perceived stress. Participants attended most BA sessions and reported high satisfaction. Participants in BA reported significantly higher levels of activation (d = 0.69, p <.0002) and environmental reward (d = 0.54, p <.003) than those who received TAU, and early change in both of these putative targets significantly mediated subsequent depression outcomes. Conclusions: BA is effective for pregnant women, offering significant depression, anxiety, and stress benefits, with mediation analyses supporting the importance of putative targets of activation and environmental reward.