Postpartum depression (PPD) is a relatively common problem, affecting between 10% and 15% of women after delivery. Although it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women who are more vulnerable.   One such group is teen mothers, where the risk of PPD is about 25%.

Researchers from Brown University have developed a program specifically for teen mothers with the goal of reducing the risk of PPD.  The intervention, the REACH (Relaxation, Encouragement, Appreciation, Communication, Helpfulness) program, is based on interpersonal therapy and is an adaptation of an interpersonal therapy based prevention intervention, which was found to be effective for reducing the risk of PPD.  In a randomized controlled trial, 106 pregnant primiparous adolescents who were ?17 years old were assigned randomly to the REACH program (n = 54) or the attention and dose-matched control program (n = 52). The women were assessed at 6 weeks, 3 months, and 6 months after delivery.

The REACH program is a highly structured, adolescent-oriented intervention that is delivered over the course of 5 one hour prenatal sessions with an in-hospital postpartum booster session shortly after delivery.  The intervention includes multimedia (video clips), interactive (role-playing) components, and homework with feedback. The program focuses on the development of effective communication skills to manage relationship conflicts, expectations about motherhood, stress management, development of a support system, maintenance of healthy relationships, goal setting, and psychosocial resources for new mothers.

This intervention delivered during the prenatal period significantly reduced the risk for postpartum depression in primiparous adolescent mothers.  The overall rate of depression in the intervention group was 12.5%, compared to 25% in the control group.

This is a relatively simple and practical educational intervention which is easy to administer and can lower risk for postpartum depression in a population at high risk for postpartum illness.  What is also notable is that while other preventative interventions focus on depression specifically, this intervention focuses primarily on difficult aspects of the normal postpartum experience and on how to increase levels of social support.  This program was piloted in an inner city population, but it is likely that most mothers – even those with better access to various resources – would benefit from this type of practical and action-oriented intervention.

Ruta Nonacs, MD PhD

Phipps MG, Raker CA, Ware CF, Zlotnick C.  Randomized controlled trial to prevent postpartum depression in adolescent mothers.  Am J Obstet Gynecol.  2013; 208(3):192.e1-6.