Depression Clinical Trial
Official title:
Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT): Intervening Early to Improve Maternal and Family Well-being.
We hypothesize that the intervention will: (1) offer a feasible approach for providing mental healthcare to pregnant women and have a high level of acceptability by pregnant women and healthcare providers; (2) reduce symptoms of depression, stress, anxiety, and parenting stress; improve parenting competence, coping, and relationship adjustment compared to usual care; and (3) reduce the risk of poor maternal-infant attachment. As such, this early intervention holds promise for reducing maternal mental health morbidity and its negative influences on infants, children, and families.
One of the main reasons that women do not receive treatment is that their mood and anxiety
problems are not detected. Despite recommendations and high rates of acceptance by providers
and women, only a minority of providers conduct psychosocial assessments as part of routine
prenatal care. Computer-based 'screening' is an acceptable and feasible approach to
assessment of sensitive issues including prenatal and postnatal intimate partner violence,
mental health problems, and postpartum depression by patients and providers. It is
well-suited for busy clinical settings and is advantageous in that it offers a consistent
approach to assessment, is resource-sparing, can be tailored to meet the specific needs of
patients, can be used with audio/video for low literacy, provides a real-time summary for
patients/providers,achieves similar or higher rates of disclosure of violence and mental
health problems, and is preferred by patients because they perceive it as more anonymous
compared to interviews or questionnaires.
However, psychosocial assessment on its own is ineffective in preventing or treating mood
disorders and unethical in the absence of treatment options. As such, many providers do not
assess pregnant women for mood disorders because non-pharmacological treatments are
frequently unavailable and pregnant women prefer them. Cognitive behavioural therapy (CBT) is
a highly effective, non-pharmacological treatment for depression and anxiety and is
recommended by perinatal national Australian guidelines as a potentially effective EARLY
intervention for reducing the risk of maternal-child outcomes.
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