How Does Comorbid PTSD Affect Collaborative Care for Perinatal Depression in Socioeconomically Disadvantaged Women?

“Before the birth, I was just really depressed, nervous, and down in the dumps all the time. I didn’t trust anyone I knew and didn’t want to see people. After getting MOMCare, I feel better and even happy. I can take care of my baby and also work. I have stuff to do and I can do it.”

—MOMCare participant

Depression during pregnancy is a potent predictor of postpartum depression. Antenatal depression is a heterogeneous condition, ranging from mild depressive symptoms to a diagnosis of major depressive disorder (MDD), and MDD may be accompanied by comorbid psychiatric conditions such as posttraumatic stress disorder (PTSD). The latter complication can make antenatal depression more difficult to treat by delaying or diminishing treatment response.

We developed MOMCare , a collaborative care treatment for pregnant women on Medicaid with probable MDD; these women were receiving Maternity Support Services in the public health system of Seattle and King County but typically did not go for treatment in the community. In our recent study, we found that two-thirds of our sample also met criteria for probable comorbid PTSD. MOMCare operated in 10 public health centers, provided case management to meet basic needs and offered a choice of brief interpersonal psychotherapy (IPT) and/or antidepressant medication from pregnancy (12–32 weeks) up to 1 year postpartum. The results of the MOMCare treatment study offer hope for these most vulnerable women and their offspring. We found that women with depression and PTSD who received MOMCare got better and stayed better from before the birth and across the first postpartum year.

Interestingly, brief IPT not only significantly reduced depression for these mothers but also ameliorated PTSD severity. Why might this be so? Potential advantages of IPT for PTSD are that it is patient-friendly and flexible and is based not on exposure to the traumatic event(s) (which some patients do not want) but on the link between the patient’s feelings and her interpersonal environment. Many PTSD symptoms involve interactions with others, such as interpersonal avoidance. Interpersonal psychotherapy for PTSD is similar to IPT for depression, requiring little to no adaptation, and specifically includes attunement to the patient’s emotion in relationships, reduction of interpersonal avoidance, increases in social support, resolution of interpersonal problems, and the exploration and validation of anger as a critical part of the therapeutic process. Evidence from a number of randomized trials also suggests that IPT is no less effective than prolonged exposure in treating PTSD in a community sample and is even more effective for patients with comorbid major depression.

So, our next step is to disseminate the MOMCare intervention for high-risk socio-economically disadvantaged pregnant women with depression and PTSD who are receiving Maternity Support Services in the Seattle-King County Public Health System. In the interest of sustainability, we hope to show that MOMCare is not only effective but also cost-effective.

Financial disclosure:Dr Grote has no relevant personal financial relationships to report.