Piece Efficacy of Interpersonal Psychotherapy for Postpartum Depression Michael W. O'Hara, PhD; Scott Stuart, MD; Laura L, Gorman, PhD; Amy Wenzel, PhD Background: Postpartum depression causes women _great sullering and has negative consequences for their ‘social relationships and for the development of their in- fants, Research is needed to evaluate the ellicacy of psy- chotherapy for postpartum depression. Metheds: 4 total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or oa waiting list con- dition (WLC) control group. Subjects completed inter~ ww and self-report assessments of depressive symp- toms and social adjustment every 4 weeks, Results: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Seale for Depression (HRSD) scores of women receiving IPT declined from 19.4 108.3, asignilicanly greater decrease than occurred in the WLC ‘group (10.8 0 168). The Beck Depression Inventory (BD) scores of women who received IPT declined from 23.6 10 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A signifi- cantly greater proportion of women who received IPT re- covered from their depressive episode based on HRSD scores of 6 or lower (37.5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Seale-Sell- Report relative to women in the WLC group. Conclusions: These findings suggest that IPT is an ef- ficacious treatment for postpartum depression. lnterper- sonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alterna- Live to pharmacotherapy, particularly for women who are breastfeeding, Arch Gen Psychiatry. 2000;57:1039-1045 OMEN of childbear- ing age are at high risk for depres- Depression, after childbirth is, partum depression is needed to prevent these problems. Antidepressant medications, cognitive behavioral therapy, and interpersonal psy- chotherapy (IPT) havebeen validated as ef From the Departments of Psychology (Drs OHara, Gorman, and Wenzel and Psychiatry (Dr Stuart) University of low, lowa City particularly problematic because of the s0- cial role adjustments required of women during this time” For example, women ‘must provide immediate and constant care for their infants. Women also face chal- lenges in thei relationships with spouses or partners, and often find that they must redefine their relationships with thelr fm- ily members and fiends. Finally, women frequently need to make adjustments in their work roles to accommodate the care required by their infants There is good evidence that mother- snfant bonding i impaired by maternal de- pression."* Morcover, several studies have documented a link between postpartm depression and later problems in chil dren’ cognitive and social-emotional d velopment." Effective treatment of post- (©2000 American Med ‘Downloaded From: http:/jamanetwork.com/ on 09/03/2017 fective treatments for major depression, Concerns about the possible effects of an- Lidepressant medications on the developing feuusand the breastfed infant have often led otheexclustonof pregnantand breastfeed- ing postpartum women [rom depression treatment tials. Such women may also ex- clude themselves because ofadesiretoavoid medication" Although there is evidence that antidepressants are relatively sale for nursinginfants,"*the American Academy of Pediatrics"? classifies mostantidepres- santsas “drugs whose effect on nursing in- fants is unknown but may be of concern.” Given these considerations, itisimportant that nonpharmacologic interventions be evaluated for use with postpartum women. ‘Although previous studies of psy- chotherapy for postpartum depression Association, All rights reserved.PATIENTS AND METHODS PATIENTS SSL er ee sid teeta et Saget mes Seca Tete og vo ef cere cree react sere Ses sc Teme Speen ater “eves ene sae aerate i ean se ‘TREATMENTS “Therapists and Training ‘Ten therapists in private practice inthe 4 communities from, which study subjects were recruited conducted the IPT treat- sent, ll were experienced psychotherapists who had PhD or PeyD degrees in clinkcal or counseling psychology. Ther sverageagewas 42 years (range, 29-51 yeas) and her mean Ievelofpoidocoralexperience was 4 yar range, 3-24 ye) Fiveof he therapist were menand S were women ache js teated between 1 and 11 patients (median 6.5). Pi rlor othe study. therapist read and became lamar with he Interpersonal Psychotherapy of Depression manual zd the mantal for Interpersonal Psychotherapy Tor Post partum Depression (unpublished manual, 1993, valable om 4.W-0. on reqs) Each therapist attended 40 hours of didactic lectures and videotape prsenations, meeting the Standard for taining of IPT therspise used in extant research projects” The traning was designed to ott com- petence in IPT and Included a detailed review ofthe eat fem manual, using videotaped sessions to state cach othe interpersonal problem areas and the strategies sed toadress them. Therapists were required to complete a 12- session course of IPT witha postpartum depressed woman asatsfactor level of competence and adherence pit to tering the eatment phase ofthe study, Dring the tea tment phase, therapists ere continually monitored fr ad- herence tothe PT treatment manuals" Therapists were re aired te videotape or sudiolape al of ther IPE sessions for Ase in supervision withthe authors Interpersonal Psychotherapy Interpersonal psychotherapy was administered in 12 our dong individual sessions dating» 12-week petid in stan- dard ashion according to the manual of Klerman et al with some medication t accommodate the postpartam con text of these depressions The inital sessions were con- ered with identifying depression as a medical word a feng pe png dereinin an npr Sonal relationships andeaing problematic aspects ofthese Feltionship tothe pints depression. Finally, the thera Pst and patent collaboratively dented the IPT problem $ea() most telated to the episode and set eatmet goal" Daring the intermediate sessions the therapist ecuscd onthe tterperona iflclies ented by the patent. Com- ‘mon postpartum and IPT problemares included conflict with partner or extended fail (terpersonal disputes), los of Fecalwork relationships (roe anston), and loess aco- Ciated wih the birth, sch as previous perinatal los or the denthoigifcant others (ge. nte ital scion the ther Pst reinforced the patents sense of competence in overcom- Ing depression, discussed plans for termination of therapy, ani worked wih the patent o develop plans should the de pression recur” 46 the results of these studies have been favorable have been compromised by design Hinitations."” For example, studies have included patients with minor depression as well as major depression,” used nonmanualized” oF “nonstandard” therapies," used therapists who were not professionally prepared (eg, health visitors, nurses)" or used therapies that "were principally aimed at improving the mother-infant relationship rather than treating depression." These limitations suggest the importance of evaluating a (©2000 American Med ‘Downloaded From: http:/jamanetwork.com/ on 09/03/2017 well-defined standard psychotherapy for the treatment of postpartum depression, We selected IPT" for evaluation because of ts dem- onstrated efficacy for major depression,!"”""2 and because lis focus on interpersonal relationships directly addresses problems experienced by depressed postpariuin women." We report the results of a controlled study of the efficacy of 12 Weeks of treatment with IPT compared with a watl- ing list condition (WLC) in the treatment of postpartum depression, Association, All rights reserved.Waiting List Condition Patents assigned to the WLC group waited 12 weeks be- fore receiving treatment. Although no therapy was pro- ‘ded during this time clinical sessment using the RSD twere conducted by telephone at 4,8, and 12 weeks after ‘ssignmentto the WLC group. Brief elephonecontactalso wwere male at 2.6, and 10 weeks to evaluate the patients Sule isk and ability to wait for treatment ‘Weelecedtouses WLC conaliion for reasons Fis, there remains substantial controversy in psychotherapy treatment rial regarding what consltues sn appropriate psychotherapy “plcebo® condition" Problems ae in- Keren in viriall all peychotherapy placebo models. The ‘se ofa no-reaient comparison in paychotherapy tras ie acknowledged asa valid comparison condition,” and i Considered io meet accepted scenic standards for ell acy thatthe elects of specific realmente better than to teaiment or equal to of beter tan am efetve aller batve teatment” Second, a WLC tellct the typical ex- perience ofthe women nthe ueatment tral, We used com- Iunty screening to recruit women forthe study and none othe women randomized tothe WLC was atively seek ing treatment. AWLC thusrefleced what would have hap- peed to these women had their depresive episodes r- fhained unidenied MEASURES, Interview Assessment modi version ofthe SCID, nonptent eition, or DSM- {¥."incombinationviththeschsotypaland antisoca mex- tls fom the SIDP-= was used to sreen women prior 10 treatmentassignment-The modified SCID included theo iGoingsectines in onder: pat periods af pepchopetbclog- cal symptoms, psychopatholagial symptoms Guring the Past month, crten sacl fetioning sd them ep Sods mod (current major depressive episode, past d= Presive episode, and djthymi). Time of onset lan- Sholie eatres, and atypia esate also were evened In addition, the SCID was modified to screen for alcohol substance abuse panic disorder, obesive-complive d+ order, anorexia nervon, and blimia nervons during the past toon, Screcning questions for previous mane Sodes or somatization disorder were also included, Fic nally the SCID prychotie screening modal, the SIDP Schigotypal module andthe SIDP antisocial module were inchuded shortened version ofthe modied SCID, which focused on the curent major depressive episode, was used during the in-home pretreatment and postretment inter “The amended 17-item version ofthe HRSD (adding ‘tems om hypersomnia, yperphagia and weight gan) wat ‘sed ac one ofthe principal outcome measures. The HRSD twas administered by an independent clinician during the Itshome pretreatment and postreatinentasessmenteand 14 and 8 weeks after group assignment. During tele Phone assessments (4 and # week and 30% of posttest fnent aseesments), tect questioning of subject clicted Information that usually was obtained through direct ob- servation (rlardation and agitation). The clinical inter- viewers who administered the HRSD were not blinded to treatment status, Our decision to use nonblinded raters was biced on our desire to minimize atrtion and our concern that we would have a high drop-out rat, parculaly in the WLC group. Hence, we eleted to use clinical infer ‘lewers who worked with the same subject throughout the Treatment tri Using intraclass correlation to account for cons tency and abso level difeences, we oblained an intra clas correlation 093 forthe 17-kem HRSD total score based on 192 interviews (38 interviews rom each assess tment period) and] separate ntrviewer-blind rater pats Selfreport Assessments Subjects completed the 1DD" during the screening phase of thestudy Patientsrandomized ios teatmentcondiion comm- pleted the BDL," theSocial Adjustment Scale-SelF- Report (SAS- SR), the Dyadic Adjustment Seale (DAS), and the Postpar- ‘tum Adjustment Questionnaire (PPAQ)."Exceptingthe DD, these measures were administered before therapy and alter 48 and 12 weeks ellowingassignment to treatment group. STATISTICAL ANALYSES ‘An independent samples 2-tsled {test was used to com= pare the IPT and WLC groups on initial demographic and Clinical characteristics. For most outcome measures (in- cluding the BDI, HRSD, PPAQ, SAS-SR, and DAS), 22 groups APT vs WLC) X 4 assessment occasions (pretherapy, + weeks, 8 weeks, 12 weeks) repeated-measures analysis of variance was conducted using an a of 05, These analyses yielded a multivariate “exact F” for the group * assess ‘ment occasion interaction. For categorical variables, a {est was employed, using an « level of 05. ll statistical tests were tailed, Sample size was determined om the ba- sis of power analysis and was increased from 108 to 120, shout two thirds of the way through the study (as PATIENT CHARACTERISTICS Recruiting letters were sent to 20620 women recently de- livered of an infant. Following several screening steps, 345 women met criteria for major depressive episode on the SCID. A total of 7 women met exclusion criteria, 152 women declined participation, and 16 women were (©2000 American Med ‘Downloaded From: http:/jamanetwork.com/ on 09/03/2017 treated as training cases, leaving 120 depressed women who participated in the study Table 1 presents the demographic and clinical char- acteristics of study subjects, Almost all study subjects were white and tended to be well educated, which is gener- ally consistent with the populations of the lowa coun- lies from which the subjects were recruited. Excluding, 3 patients who were experiencing a chronic depression (episode length >2.5 years), the average episode length for study subjects was approximately 7 months. Association, All rights reserved.‘Table 1. Demographic and Clinical Characteristics of Study Subjects ieny Bae 207245 Parner age y mysse 311452 Eduetion 145.200 149318 Parte dca, y 1gs22 148.21 Working, yes ea a3 Marriage lant, y 52437 $4432 Pari, primiparous 287 ma Boasting, yes sno a5 Past major depressive episode, eyes 65.7 a3 Posigartum ost," yes a3 a3 Episode nat, mo aost29 75472 Eryn pete, mo 612079 622070 Dat ae preseted as mean = SD ule eters acted. PT lndeatsinepesona psychoteapy WLC, wang ist conaton Noe of these ferences was stastcalysniteant AP 20 except breasteding (= 08) There was no rato between beasteang and eaten sient for ether he Hatton Rating Scale fr Depression othe Beck Depression invent om? 60) “inthe IPT and WLC condos bveasteedng data wee missing for 10 and 6 subjects becuse a retospecte colecton, ATTRITION Twelve (20%) of 60 patients withdrew from the IPT group and 9 (15%) of 60 patients withdrew from the WLC group, a nonsignificant difference (xi <1, P=.47) Overall, 42.9% of the attrition occurred within the fist 4 weeks, 23.8% occurred between 4 and 8 weeks, and the rest occurred between § and 12 weeks after treatment assignment. There were no significant differences between dropouts and completers on any demographic ‘or clinical variables. OUTCOME ANALYSES: DEPRESSION The original design called fora repeated-measures (pre- therapy and 4, 8, and 12 weeks after beginning of therapy) analysis of covariance using the presence/absence of prior major depressive episode as a covariate, Because this fac- tor had no effect on BDI or HRSD outcomes (¢ in both ceases <.35, P>.7), Itwas not used as a covariate in the analyses, Intention-to-Treat Analyses Intention-to-treat analyses, which inclided all subjects assigned to the IPT or the WLC group, were conducted forall measures of depression, A repeated -measuresanaly- sis of variance using the HRSD revealed a signifieant group X assessment occasion interaction in favor of IPT (ex- ct Py 25.00, P=.003). There was a significant group X assessment occasion interaction in favor of IPT based ‘on BDI scores (exact F 45=6-45,P <001). Recovery was defined a priori as an HRSD score of 6 of lower oF a BDI score of 9 ar lower.” Recovery rates based on HRSD scores favored treatment with IPT (31.7%) over the WLC (15%) (xi=4.06, P=.03). Based on BDI scores (BDI =9), pa- tients treated with IPT had a significantly greater rate (©2000 American Med ‘Downloaded From: http:/jamanetwork.com/ on 09/03/2017 Table 2, Depression Outcomes for Completer Subjects* Trrorep wie rou (W=4s) 23H) states RSD (Gtel Fs = 10.0, P00) Inal = 10dads 1853 Avene 150265 183.252 7507 Suess 126270 164265 a0 Tewake 83453 168284 98001 ‘I (xaet Fas = 8.89, P=.001) Intl == 286472 Za0s60 Aves 77280216081 ‘we Suess 126275 121089 ‘001 Twede 06268 192487 <001 =/PT ideas erpersonal psychotberapy, WLC, wang It condition RS, Harton Rang Seale for Depression, BOL, Beck Derescon Imenton and elise, not aplabie. of recovery (38.3%) than did women assigned to the WLC group (18.3%) (x'=5.91, P=.02) Completer Analyses A repeated-measures analyses of variance for both the HRSD and the BDI revealed a significant group X assessment oc- casion interaction in favor of IPT (Fable 2). Follow-up ¢ {ests comparing the IPT and the WLC groups revealed that significant differences on the HRSD and BDI were al- ready apparent atthe 4-week assessment (Table 2). Palients receiving treatment with IPT were signifi- cantly more likely to meet recovery criteria on the HRSD (37.5%) than patients in the WLC group (13.7%) (xi=7-40, P=.007). Inaddition, a significantly greater pro- portion of patients treated with IPT recovered based on BDI criteria (43.8%) than patients assigned to the WLC group (13.7%) (x=10.99, P=.001). Finally, signifi- cantly fewer women in the IPT group met criteria for DSM-IV major depressive episode at the 12-week assess- ment (12.5%) compared with women in the WLC group (€8.6%) (x}=32.1, P<.001), We also evaluated response to treatment (defined a priori as =50% reduction in symptoms). Based on HRSD scores, significantly greater proportion of patients treated with IPT responded to treatment (62.5%) than patients, assigned to the WLC group (17.6%) (x=20.84, P<.001). Similarly, based on BDI scores, a significantly greater pro- portion of patients receiving treatment with IPT re- sponded to treatment (60.4%) than patients in the WLC group (15.7%) (xi=21.14, P<001). OUTCOME ANALYSES: PSYCHOSOCIAL ADJUSTMENT For the SAS-SR, there was a significant group X assess- ‘ment occasion interaction in favor of IPT (Table 3). Fol- low-up {tests revealed that significant differences in the predicted direction emerged at the 4-week assessment (able 3). Each ofthe relevant subscales showed signifi cant group X assessment occasion elects in favor of IPT Including “work in the home” (exact Psys= 19), Association, All rights reserved.work outside of the home” (exact F, 4=7-41, P<.001), relationship with spouse” (exact P,=722, P<.001), relationship with children older than 2 years” (exact F,oi=2.78, P<.05), “relationship with immediate fam- lly" (exact F,.,=5.15, P2.002), and “relationships with friends” (exact P, ..=4.88, P=.003), ‘On the specific measure of postpartum adjust- ment, the PPAQ, there was. significant group assess- ment oceasion effect in favor of IPT (Table 3). Fol- low-up tests revealed that significant differences in the predicted direction emerged at the 8-week assessment (able 3). Several subscales showed similar significant [group X assessment occasion elfects in favor of IPT in- cluding “work in the home” (exact F,»,=4.61, P=.005), relationship with spouse” (exact Foi =487, P=.003), relationships with children other than the baby" (exact F,y=4-67, P2005), and “relationships with friends” (ex- act F ,y4=2.72, P=.05). In contrast to the case for the SAS- SR, there was nota significant elfect for “work outside fof the home” (exact F,..=1.54, P=.22), or “relation ships with other family members" (exact F,,=2-43, P=.07). Also, there was not a significant difference be- toveen the 2 groups on the “relationship with new baby subscale (exact F,,,=1.00, P=.13). This may be due to the fact that even prior to therapy, women in both con- ditions were reporting very little dissatisfaction/ disturbance in their relationship with their infants, The final psychosocial measure that was obtained at each of the 4 therapy assessments was the DAS, a spe- tific measure of adjustment in relationship with part ner. There was not a significant group X assessment oc- ‘casion effect for this measure (Table 3). However, there Was a significant group X assessment occasion ellect for the Dyadic Satisfaction subscale of the DAS in favor of IPT (exact P,.,=3.13, P2.03). The interaction effects for the 3 other subscales, Dyadic Consensus, Dyadic Cohe- sion, and Alfectional Expression, were not significant. Lees Interpersonal psychotherapy resulted in significant im- provement in depressive symptoms relative to the WLC based on (1) the absolute reduction in symptom levels as measured by the HRSD and the BDI; (2) the propor- tion of women who responded to treatment (ie, =50% reduction in symptom severity as measured by the HRSD and the BDI); (3) the proportion of women who met HRSD and BDI criteria for recovery, and (4) the proportion of Women who no longer met DSM-IV criteria for major de- pression, Women assigned to the WLC group experi- ‘enced litle improvement over 12 weeks (15% and 17% reduction in symptoms based on the HRSD and BDI, re spectively), suggesting that recovery without treatment ‘occurs slowly. Moreover, these women had already been. depressed for an average of about 7 months prior to the beginning of the waiting period, The efficacy of the treal- ment with IPT, the lack of improvement in the WLC ‘group, and the long duration of these episodes all point to the importance of beginning treatment with postpar- tuum depressed women as soon as possible Patients receiving IPT for postpartum depression had significant improvement in their psychosocial function- (©2000 American Med ‘Downloaded From: http:/jamanetwork.com/ on 09/03/2017 Table 3. Psychosocial Outcomes for Completer Subjects* {rr aroep wie areu (a4) 23H) states SoeialAosnen Seal Soir Report (ral Fi Intnl 24s aT 28a a7 Aveske 226235 2472 40 Byes 2052.33 2262 42 Hvmeke 1992.3 250 45 osigatum Adusinont uesionaire (at, Init 27a a 2a 28 Aveske 2502.36 2662.22 iis Bese 24231 2622.26 n Hwmeke 2986202572 28 ‘001 ‘yadle ajetment Seale (xa Fe 18) Init "08621045 87.602 24.66 Aveske 9732203 870422499 ry Buel 100372192 886522562 an H2uesks 1011022078 $86022757 an ~/PT inate nepersonapsychoterany WAG, wating It condition cipes, ot appeabe, and HS, nina ing based on the SAS-SR and the PPAQ compared with women in the WLC group, Findings from both measures converged to suggest that women's adjustment in man- aging their houscholds, as well as their relationships with their partners and children (other than their infants) im- proved as a consequence of treatment with IPT. How- ever, these patients did not reach normative levels on el- ther measure.” Women did not report much disturbance im their relationship with their new infants even before therapy, leaving relatively litte room for improvement In contrast to scores reflecting patients’ relation- ship with their infants, the pretreatment DAS total scores (mean=00.4) easily met the criterion for marital dis- tress (score <100) used in other treatment studies." Treatment with IPT resulted in an increase of about one third of an SD in overall marital adjustment compared with no change in the marital adjustment of the women in the WLC group, though this difference was not sta- Listicaly significant, However, the Dyadic Satisfaction sub- scale did show a significant change associated with treat- ment. This subscale includes critical tems reflecting, contemplation of divorce, arguing, thinking positively about the relationship, overall happiness, and comm ‘ment to the relationship, among others."* These types of lems may reflect characteristics of the relationship that are dependent on the woman's personal perspective more than the partner's behavior. Change in other aspects of the relationship may require the participation in therapy of both members of the dyad. During the weatment phase of the study, we used clinical evaluators who were not blinded to the subject's lweatment status, There were 2 reasons we chose not to use blinded clinical evaluators, First, we believed that keeping interviewers blind to treatment status when one grolip Was receiving treatment and one group was nol would have been nearly impossible, We were con- cerned that subjects could to0 easily (or inadvertently) reveal whether or not they were receiving treatment. Se¢ Association, All rights reserved.‘ond (and more importantly), we believed that establish- ing a relationship between the clinical evaluators and the study subjects would serve to reduce attrition, particu- larly for the women assigned to the WLC group. The low ‘overall attrition rate of 17.5% suggests that addressing this potential problem was helpful, particularly given the low rate of attrition in the WLC group, There are several streams of evidence suggesting that the HRSD scores obtained in our study were not compro- mised by the lack of independent evaluators. First, BDI and HISD scores were highly correlated and gave essen- tially the same results. Both the proportion of patients who, ‘were recovered and the proportion of patients who re- sponded to treatment were similar when BDI and HRSD scores were compared. Moreover, there was a high level ‘of agreement, both with respect to consistency and abso- hue level of rating, between a fully blinded clinical evalu- ator who rated tapes of the clinical interviews and the clini- cal evaluators who conducted the interviews, To assess bias on the part of the clinical interview= cers, who were not blind to the experimental condition of subjects, we also determined the absolute differences in HRSD scores for the clinical interviewer and blind rater between the IPT and WLC groups. We examined this ques tion statistically with 3-way analysis of variance. The 3-way interaction, 2 groups (IPT, WLC) X 4 assessment ocea- sions (pretherapy, 4 weeks, 8 weeks, 12 weeks) X 2 rat cers (blind, nonblind), that would suggest bias in favor of the IPT group, was not significant (exact F,,s=1.58; P=.20). Inaddition, the absolute differences between the blind and the nonbiind raters were quite small, particu larly atthe intial and 12-week assessments (intial and. 12- ‘week assessment differences both 0.1 on the HRSD). These Lindings converge to suggest that biases in the HRSD rat- ings, ifthey occurred, were negligible Study participants were mostly white, in a relatively stable relationship with a partner, and on average were rela- tively well educated. Participants also had few comorbid diagnoses and had relatively long episodes of depression, prior to entry into the study. Asa consequence, future re search on IPT for postpartum depression should include patients from more urban settings that have larger poput- lations of minority women and women who have comor- bid diagnoses such as panic disorder. The findings ofthis stidy have several important im- plications. First, women suffering from postpartum de- pression should be treated as quickly as possible. The long, ‘duration of episodes prior to enrollment in our study and the minimal change in symptoms in women who did not receive treatment both suggest that nothing is tobe gained by delaying treatment. Second, IPT isan effective treat- ment that can be offered to depressed postpartuin women ‘with confidence. The availability of an elficactous non- pharmacologic treatment is important because many ‘women may wish to avoid taking psychotropic medica- tions if they are breastfeeding (more than 40% in our sample), and because there isa relative paucity of con- trolled research on the efficacy of antidepressant medi- ‘cation for depression in the postpartum period.’ These Lindings should give clinicians confidence that IPT is an clfective and acceptable treatment for postpartum de- pression. (©2000 American Med ‘Downloaded From: http:/jamanetwork.com/ on 09/03/2017 Accepted for publication May 15, 2000. This work was supported by grant MH50524 from the National Institute of Mental Health, Bethesda, Md (Dr Otara) Portions of this work were presented at the Biennial Meeting of the Marce Society, lowa City, owa, June 27, 1998, We thank the therapists and study staff: Jane Ander- son, PHD, Juan Aquino, PhD, Sandra Davis, PhD, Susan Enzle, PhD, Ronald Hilliard, PRD, Perry Howell, PsyD, Ana Lopez-Dawson, PhD, James Marchman, PhD, Ronald Nel- son, PRD, Patricia Rebeck, PhD, Deborah Van Speybrocck, PD, Elizabeth Rose, PRD, Rebecca Ready, MA, Karin Larsen, MA, Carol Mertens, PRD, and Melody Weig. We also thank Jill France, Bureau of Vital Records, lowa Department of Public Health, for her assistance Reprints: Michael O'Hara, PhD, Department of Psy- chology, University of lowa, Iowa City, 1A 52242. LES} 1. Myers, Weismzn WM, Tih L, Hor CE eat PJ, Onasch A ‘hen JC Boy, Burke JO, Kamar Satan. Sth prelnee pei cer nthe communis Arh Gen Pee BE ‘eer 2 Hara NW, Swain AM. tes and isk of postgarum depression: mete nai nt Re ayia. 196 897-5 {OHM ota, J, lps LAC Wok Adjuster inclbening ‘oman te Postpartam AjstctOuestonaire. Psychol Assess 100: eae. 4 Cummings ME Dis PT Parra pression tm nctning and child ag user i factors, processes, nd pays. cect, Toth Le Develop Perspectives on Depression Roch star Prone 1082 280-22, 5. Downey, Coyne JC Chaon af eptesseparents an nara tio, Py ol Bal 199010850-76 6. Oa MW Postpanum depression: cases an conequncs New Ya, etna cf Depression Clabes Reseach Progam tral tects ofan Arch Gan Pye, 104671 982. 8 Ein Patt MB, Hada SA Ay J. Tet of Dpesin Cok labore Resch Poa: backround and resewch plan. Ach Gun P han 1085:2305-316 8 Apply L, Warner Whiston 2 eng bhai ou uy Toor stes2 36 gui ALP Kunar Evert Henderson A, Studd. Tznealos- ‘roger vstentt sewapsiaatl dapeson Lancet 105 37 235853 Wer KL are JM, Fading RL. Aneprssat weaent dung b feeding Ar Joya 106 1581 122-157 ‘Stone, Oven A Lindy Kits DT Laval Memeo 8 Se ton and cematyrrane naman bres ik nd ning sas. Psych 1907154 125-1280 mean Kee of Pate Comte on Drag. Th ater ot rand ‘ther cee ta burn milk Pedi, 1QE6137-160, Hola, Saory RCo. Comeling a gna race sting on- trol tty ofa vis nerenton rasan of postal depression. BUA, 198 208223-26, Wilber Hang, CP Counsslig of posta dgresson: acon study ona poplin based Sueish samp. J Acts 108630200216 oop Mura Te inp of pyeoloea etnans ops eon oa marl mood an inant development: Muay L Cooper ‘is. Pspartum Depression and Chi Dvslopman New York, Y: Gio scaz20t220 Suit, OHara MM. Paychotaapis Sie Yonkers KA Esso Mood isarasin Women Landon, Engl Marin Dunc Pubihas. Ib pres ean GL, Weisman A, Runes, Cetan ES. Iprsona Py hth of Deesion New Yah, NY: Bai Boos, 198 argh 8, A cond dy of fuosne ling heater posal depression Association, All rights reserved.2 a 2 a en 28 2% a. Ey Ey Downloaded From:: Matson, Wsiesmsn WM, Mee, Gana Ray titres ‘hor fr dprased dace Arch Gen Pci, HESESTS 578 Wossman AM Maron. erpetsnal pspbaterap:curen sts Ah Gen Pye 100431 50-508 Sur S Oars AV ternal shots fr postu depression ‘ateatnantproyam. J Psycho Pact Rs 10561828 Sar §, OMaa MU Teamsnt of partum depesson wih insrpesonl psyehthaap la, Ach Gen Psjhaoy. 185827576 “mean Cone W. The vera Diagoase Depesion (DO: st reporsaetodagose mor desi sores, J Cosa in sea 17 5555.0. Shite A, las 8, bon Fst MB. The seucured lnc neaw {or DSU (SCD) stay atonal, and depression Arch Gn Poh 1, tnenent zo Fist, Spite RL bon Wars BW. Sructred Cal ei fr DSI Aus Disorder, Resch Vso. Non pation He Yor New "York Sa Psychiat 187 amit HA Develop of atg salar pinay depres ness. 8 4S lo Pach 10575278295. ‘anurans Asssaton, Daprost an Satta Mana of Mon Dis drs, Fourth Fan Washington, OC: Ameren Psychic Associaton; 1004 Pel lan i Zirmarman Struct Cn! for DSMAV Par sonal (S1DP1Y, Washingon, DC: Amacan Paya Associaton 87 outatil Bl, Oley SS, Fly 8, Weiss MM lof mar guded eepguneD) TECHGEN BYCHATINOL 37 NOW 2. a 2 2 au 2. 28 a. Py 2. ‘ining conde and fcc of irprsonalpayheteray fr depres Sin. Cans in Poel 0085 $81- 58, Nathan PE, Sua, Dan SL. Research an psyehtarapy cay and etic. ‘hanes betwen Sela and Gans? Pet Buln rss. Part MB Pst canals sjhaterapy ean: ase quran oral ‘abo or ach poble? J Cnet Gin Peta 108554747. Honath :Paceoe and conmon actors no acaes pyc Sear Payetl Bul 188 0K 225, Lan Kran 6. Evuag payer A J sein 198219 ror BuckAT, Ward, Mendon M, Macks, aug Anime for measur ing depression Ach Gor Paychiy.161:A561 589 Weissman Hal, tl semen toca afte by pte st rape. Arch Geo Pacha 1OTSSE111-118 Syne Measuring dja ase rasaes for asssing ta uty fimarrago an sea jas Marge Fa. 197381528. Weissman Past BA, Tompson WD Sei adjstent by selapoin ‘cammaniy sale andi pyc oupaens, JN Met Di 17818 708 (Leary XO, Beach SRK. hapa abl etme or dpressin and matt cord. AJ Pye, 190,47: 18-186. Bauer DH Ses SL Sie, Suplamarng bavi mara hap th ogni estururn and enoveral expressiveness raning an aca i vesigatn J Cosut Cin schol 190 8536-55 (©2000 American Medical Association, All ights reserved. http:/fjamanetwork.comy on 09/03/2017