Predictors of the longitudinal course of postpartum depression following interpersonal psychotherapy.

OBJECTIVE: We examined the course and predictors of postpartum depression in the 18 months following interpersonal psychotherapy (IPT). METHOD: We enrolled 120 community women with major depression in a 12-week randomized trial of individual IPT during the postpartum period (O'Hara, Stuart, Gorman, & Wenzel, 2000). At 6, 12, and 18 months posttreatment, women participated in clinical interviews to establish the course of depression over the previous 6 months. We used survival analyses to characterize recovery and recurrence in the follow-up and growth curve modeling techniques to identify predictors of change in depression during the follow-up period. Potential predictors included severity, chronicity, and personal history of depression. RESULTS: Of 35 women who recovered with acute treatment, 20 (57%) achieved sustained recovery during follow-up; average time to recurrence was 33.40 weeks (SD = 18.43 weeks). Over 80% of women who did not recover with acute treatment experienced recovery at some point during follow-up; average time to recovery was 28.60 weeks (SD = 17.51 weeks). Time depressed each month decreased over the follow-up period. Posttreatment depressive severity and length of the index episode predicted changes in depression over time. Posttreatment depression severity, personal history of depression, and weeks of treatment in the follow-up were significant predictors of time depressed during follow-up. CONCLUSIONS: IPT resulted in long-term benefits past the termination of acute treatment, even for women who did not initially recover. Though the vast majority of women who did not recover with acute treatment did recover during the follow-up period, continuation of IPT may accelerate the process.

Sexual function in the postpartum period: effects of maternal depression and interpersonal psychotherapy treatment.

Women's sexual functioning in the postpartum period is understudied given its potential impact on women's mental health and their relationships with their partners. The sexual functioning of women with postpartum depression (PPD) in particular is not well characterized. The goals of this study were to examine factors associated with the sexual functioning of postpartum women and to compare the long-term sexual functioning of depressed postpartum women treated with interpersonal psychotherapy with a group of postpartum women who had never been depressed. Depressed (120) and never depressed (56) postpartum women were enrolled. Self-report questionnaires and clinician-rated measures were completed at initial entry to study, immediately post-treatment, and at 6, 12, and 18 months post-treatment. Analyses revealed significant differences in sexual interest between depressed and never depressed postpartum women (t (171) = 11.82, p <0.001). Although sexual interest improved significantly following treatment for depression (t (104) = -3.18, p < 0.01), those women who fully recovered continued to experience less interest (F (2, 140) = 32.24, p < 0.0001) and less sexual satisfaction through 2 years postpartum than never depressed women. These findings suggest that differences in sexual functioning exist between depressed and never depressed postpartum women, even after depressed women are treated and have recovered from their depression. Clinicians should inquire about changes in sexual functioning when treating women with PPD.

Barriers to care for antenatal depression.

OBJECTIVE: This study examined the individual-level factors impacting pregnant women's access to mental health treatment for depression. METHODS: A total of 1,416 pregnant women receiving prenatal care completed measures of depressive symptomatology, willingness to seek treatment for depression or anxiety, and perceived barriers to seeking such care. RESULTS: Women with Beck Depression Inventory scores >or=16 (indicating possible depression) (N=183) were more likely than women with lower scores (N=1,233) to identify the following barriers: cost, lack of insurance, lack of transportation, long waits for treatment, previous bad experience with mental health care, and not knowing where to go for treatment. Lower income was correlated with increased endorsement of cost and transportation as barriers. CONCLUSIONS: Results suggest that addressing financial and logistical barriers through changes in mental health services and policy will improve access to care for antenatal depression. However, attending to these issues alone will not address additional important barriers to care such as lack of trust.

A qualitative investigation of Muslim and Christian women's views of religion and feminism in their lives.

This qualitative investigation explored a relatively understudied aspect of cultural diversity: feminism and religion in the lives of religiously diverse women. More specifically, structured interviews were used to investigate views of religion, women's issues, gender roles, culture, and feminism for a small group of Muslim and Christian women living in the United States. The data were analyzed using consensual qualitative research methods (Hill, Thompson, & Williams, 1997). Findings indicated a complex relationship between feminism, gender roles, culture, and religion for these women with the majority of the Muslim women reporting that their religion supports feminist principles and identifying themselves as feminist. Christian women were less willing to endorse the feminist label. Implications for multicultural feminist practice are discussed.