Postpartum Depression in Women Receiving Public Assistance: Pilot Study of an Interpersonal-Therapy-Oriented Group Intervention
Abstract
OBJECTIVE: This study investigated whether a preventive intervention based on the principles of interpersonal psychotherapy administered to pregnant women would reduce the risk of postpartum major depression. METHOD: Thirty-seven pregnant women receiving public assistance who had at least one risk factor for postpartum depression were randomly assigned to a four-session group intervention or to a treatment-as-usual condition. Thirty-five of the women completed the study. Structured diagnostic interviews were administered to assess for postpartum major depression. RESULTS: Within 3 months after they gave birth, six (33%) of the 18 women in the treatment-as-usual condition had developed postpartum major depression, compared with none of the 17 women in the intervention condition. CONCLUSIONS: A four-session interpersonal-therapy-oriented group intervention was successful in preventing the occurrence of major depression during a postpartum period of 3 months in a group of financially disadvantaged women.
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Existing perinatal mental health interventions have been designed for low-risk outpatients and are not aligned with the unique needs of hospitalized antepartum patients.
“Existing perinatal mental health interventions have been designed for low‐risk outpatients [22, 23, 24, 25], and they are not aligned with the unique needs of hospitalized antepartum patients.”
From Mental health needs among patients experiencing extended antepartum hospitalization: A qualitative study (2026) · cites this paper as [25]
Existing perinatal mental health interventions have been designed for low‐risk outpatients and are not aligned with the perspectives and needs of high‐risk inpatients facing acute stressors.
“However, existing perinatal mental health interventions have been designed for low‐risk outpatients [22, 23, 24, 25]; they are not aligned with the perspectives and needs of high‐risk inpatients facing acute stressors.”
From Mental health needs among patients experiencing extended antepartum hospitalization: A qualitative study (2026) · cites this paper as [25]
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“The two prenatal depression intervention studies (Spinelli & Endicott, 2003; Zlotnick et al., 2001) have been tested in public assistance and specialty mental health services, not primary care, and neither followed women across the perinatal period.”
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“The first study (Zlotnick et al., 2001) was a pilot study (n1⁄437) that randomized women on public assistance who were between 20 and 35 weeks' gestation and at high risk for developing PPD to the IPT-based intervention and usual care condition or to only the usual care condition.”
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Preventing postnatal depression in mothers of very preterm infants: a randomised controlled trial
Hagan, R., Evans, S. F., & Pope, S. (2004) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2004.00165.x · Cited by 79 · see citing works
Crockett, K., Zlotnick, C., Davis, M., Payne, N., & Washington, R. (2008) · Archives of Women's Mental Health · doi:10.1007/s00737-008-0036-3 · Cited by 73 · see citing works
“The ROSE Program has demonstrated efficacy in reducing postpartum depression in pregnant women on public assistance at risk for PPD ( Zlotnick et al. 2001, 2006 ).”
MethodSelf-citationThe effectiveness of antenatal interventions to prevent postnatal depression in high-risk women
Clatworthy, J. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.02.029 · Cited by 75 · see citing works
“The IPT interventions (Grote et al., 2009; Zlotnick et al., 2001; Zlotnick et al., 2006) focussed on indentifying andmanaging interpersonal conflict.”
BackgroundMethodPreventing Postpartum Depression Part II: A Critical Review of Nonbiological Interventions
Dennis, C. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404900804 · Cited by 77 · see citing works
“Interpersonal psychotherapy Zlotnick and others (20) Pilot RCT: I Poor I”
BackgroundMethodDimidjian, S., & Goodman, S. H. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.11.008 · Cited by 75 · see citing works
Intervening to reduce depression after birth: A systematic review of the randomized trials
Lumley, J. M., Austin, M., & Mitchell, C. (2004) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462304000911 · Cited by 75 · see citing works
“The intervention was implemented in groups in four other trials (Buist [16], Brugha and colleagues [14;15;99;100], Stamp and colleagues [92;93], Zlotnick and colleagues [105]).”
MethodA mother–infant therapy group model for postpartum depression
Clark, R., Tluczek, A., & Brown, R. (2008) · Infant Mental Health Journal · doi:10.1002/imhj.20189 · Cited by 74 · see citing works
Interpersonal Psychotherapy to Reduce Psychological Distress in Perinatal Women: A Systematic Review
Bright, K. S., Charrois, E. M., Mughal, M. K., Wajid, A., McNeil, D. A., Stuart, S. P., Hayden, A., & Kingston, D. E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228421 · Cited by 74 · see citing works
“(2001) [82] 3 2 1 3 1 1 1 2 3 Zlotnick et al.”
BackgroundMethodInfluentialHalbreich, U. M. (2004) · CNS Spectrums · doi:10.1017/s109285290000897x · Cited by 71 · see citing works
Beyond screening: assessment of perinatal depression in a perinatal care setting
Miller, L. J., Shade, M., & Vasireddy, V. (2009) · Archives of Women s Mental Health · doi:10.1007/s00737-009-0082-5 · Cited by 68 · see citing works
“This stands in marked contrast to the low patient acceptance rates found in prior studies using other models (Bruglia et al. 2000; Zlotnick et al. 2001; Carter et al. 2005).”
ResultPrevention of depression: The state of the science at the beginning of the 21st Century
Barrera, A. Z., Torres, L. D., & Muñoz, R. F. (2007) · International Review of Psychiatry · doi:10.1080/09540260701797894 · Cited by 65 · see citing works
Gross, K. H., Wells, C. S., Radigan-Garcia, A., & Dietz, P. M. (2002) · Maternal and Child Health Journal · doi:10.1023/a:1021110100339 · Cited by 65 · see citing works
The prevention and psychotherapeutic treatment of postpartum depression
Stuart, S. P., O’Hara, M. W., & Gorman, L. (2003) · Archives of Women s Mental Health · doi:10.1007/s00737-003-0003-y · Cited by 63 · see citing works
“Zlotnick et al. (2001) randomized 37 women at risk for postpartum depression to either four group sessions of interpersonally oriented psychoeducation (n 18) or to a control group (n 19).”
Prevention of Mental Health Difficulties for Children Aged 0–3 Years: A Review
Izett, E., Rooney, R. M., Prescott, S. L., Palma, M. D., & McDevitt, M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.500361 · Cited by 68 · see citing works
Group therapy and its barriers for women suffering from postpartum depression
Ugarriza, D. N. (2004) · Archives of Psychiatric Nursing · doi:10.1053/j.apnu.2004.01.002 · Cited by 63 · see citing works
Gao, L., Xie, W., Yang, X. N., & Chan, S. W. (2014) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2014.06.006 · Cited by 63 · see citing works
Should Postpartum Depression Be Targeted to Improve Child Mental Health?
McLennan, J. D., & Offord, D. R. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200201000-00008 · Cited by 63 · see citing works
Leonardou, A. A., Zervas, Y. M., Papageorgiou, C. C., Marks, M. N., Tsartsara, E. C., Antsaklis, A., Christodoulou, G. N., & Soldatos, C. R. (2009) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646830802004909 · Cited by 62 · see citing works
“A small pilot study employing interpersonal psychotherapy during pregnancy is promising, yet awaits replication with a larger study sample (Zlotnick et al., 2001).”
BackgroundLe, H., Muñoz, R. F., Soto, J. A., Delucchi, K., & Ippen, C. G. (2004) · Hispanic Journal of Behavioral Sciences · doi:10.1177/0739986304269165 · Cited by 62 · see citing works
Interpersonal factors and perinatal depressive symptomatology in a low-income Latina sample.
Diaz, M. A., Le, H., Cooper, B. A., & Muñoz, R. F. (2007) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/1099-9809.13.4.328 · Cited by 61 · see citing works
Targeted group antenatal prevention of postnatal depression: a review
Austin, M. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.00086.x · Cited by 60 · see citing works
“study because of its small numbers (26).”
BackgroundInfluentialPrevention of postnatal depression
Mallikarjun, P. K., & Oyebode, F. (2005) · The Journal of the Royal Society for the Promotion of Health · doi:10.1177/146642400512500514 · Cited by 59 · see citing works
Psicoterapia de grupo: como surgiu e evoluiu
Bechelli, L. P. D. C., & dos Santos, M. A. (2004) · Revista Latino-Americana de Enfermagem · doi:10.1590/s0104-11692004000200014 · Cited by 59 · see citing works
What interventions may reduce postpartum depression
Lumley, J. M., & Austin, M. (2001) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/00001703-200112000-00009 · Cited by 58 · see citing works
Stevenson, M., Scope, A., Sutcliffe, P., Booth, A., Slade, P., Parry, G., Saxon, D., & Kalthenthaler, E. (2010) · Health Technology Assessment · doi:10.3310/hta14440 · Cited by 57 · see citing works
Poleshuck, E. L., & Woods, J. R. (2014) · American Psychologist · doi:10.1037/a0036044 · Cited by 52 · see citing works
- Authors
- Zlotnick, C., Johnson, S. L., Miller, I. W., Pearlstein, T., & Howard, M.
- Affiliations
- Brown University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2001-04-01
- Volume
- 158
- Issue
- 4
- Pages
- 638-640
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2103530046
- Cited by
- 304
- References
- 15
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 10 · 2022: 9 · 2021: 8 · 2020: 5 · 2019: 8 · 2018: 8 · 2017: 6 · 2016: 7 · 2015: 10 · 2014: 17 · 2013: 23 · 2012: 11
- FWCI
- 14.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- postpartum depression, interpersonal psychotherapy, group intervention, prevention, pregnant women, social assistance, low-income women, financial disadvantage, maternal mental health
- MeSH terms
- Adolescent, Adult, Female, Humans, Interpersonal Relations, Life Change Events, Personality Inventory, Pilot Projects, Pregnancy, Prenatal Care, Psychotherapy, Group, Public Assistance, Risk Factors, Depression, Postpartum, Postpartum Period
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