Embedding Perinatal Depression Screening and Prevention Services for Latina Immigrants Into WIC

Introduction: Perinatal depression is a significant public health problem and access to routine screening remains elusive.  Although cognitive behavioral treatments are effective for perinatal depression, few women access mental health services during this period.  A growing body of research suggests that cognitive behavioral theoretical (CBT) approaches may reduce depression in high risk women.  But there is a need to embed these preventive interventions into settings where high risk women receive other services.  This paper presents results of an effectiveness trial to integrate the Mothers and Babies (MB) course into an urban Women, Infants, and Children (WIC) program that was co-located at a federally qualified health center (FQHC).  WIC currently serves half of all infants born in the U.S., making it an important federal program in efforts to reach high-risk, low income perinatal populations. 

Methods: WIC nutritionists were trained to administer the Patient Health Questionnaire (PHQ-2; Kroenke et al., 2003), a two-item depression screen, as part of their intake.  Pregnant and postpartum women scoring positive on the PHQ-2 were then referred to social services staff for a PHQ-9.  One hundred low-income Latina immigrant women at high risk for perinatal depression (PHQ-9 score: 9-14) were invited to participate in the 6-week MB course, a CBT group intervention teaching women mood regulation skills.  Assessments were conducted at pre- and post-intervention, and at 3 months post-intervention.  We hypothesized that women who completed the intervention (Completers:  ≥ 3 classes) would report fewer depressive symptoms than two non-completer (NC) groups (NC0 = 0 classes, NC1 =1-3 classes).  The Postpartum Depression Screening Scale (PDSS; Beck & Gable 2000) served as the measure of depressive symptoms.

Results: Preliminary results are available from the first 53 participants, the majority of whom were Central American (74%) and married/partnered (74%).  Of the 53, roughly half attended three or more classes (n=25), 12 attended 1-3 classes, and17 were unable to participate in the intervention.  Among the Completers, there was a statistically significant reduction in their depressive symptoms from baseline to post-intervention (F=4.99, p<.01). These preliminary results suggest that the intervention was effective in reducing their risk for a depressive episode.  By May 2013, we will have completed data collection and will present results for the complete sample (N=100). 

Conclusions: These findings suggest that the MB course could be successfully integrated into a WIC program.  They also contribute to the growing evidence that cognitive behavioral approaches can be effective in reducing depressive symptoms among Latina immigrant women. While embedding screening and prevention services within WIC presented our team with some challenges, our lessons learned have implications for potential replication for other low-income, ethnic minority WIC populations.