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“Childhood maltreatment confers life-long risk for general and mental health disorders and affects the development of stress-responsive neuropsychiatric symptoms,” wrote Katherine Wisner, M.D., of Northwestern University and colleagues. “The regular (and crisis) telephone availability of a supportive clinician is a comforting and empowering resource that appears to be particularly therapeutic to women with childhood sexual abuse.”
The trial involved 628 women who screened positive for depression (a score of 10 or greater on the Edinburgh Postnatal Depression Scale) four to six weeks after giving birth. The women were randomly assigned to receive either DCM or enhanced usual care (EUC). The DCM program involved regularly scheduled calls from a clinician who provided ongoing education, assisted with decisions about medication use during breastfeeding, monitored patient symptoms and progress, facilitated access to mental health services, and more. Women in the EUC group were given educational materials, encouraged to contact their health plan to facilitate treatment, and received one follow-up call.
Independent evaluators followed up with women in both groups at three, six, and 12 months postpartum to assess their health, functioning, and use of health care services. At 12 months, both groups showed significant improvements, with SIGH-ADS (Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement) and function scores significantly improving by at least 50% from baseline. Women in both groups reported similar health service use as well.
Women with a history of childhood sexual abuse (about 20% of the participants) responded more favorably to the DCM program compared with the EUC condition. For example, the SIGH-ADS scores of women with a history of childhood sexual abuse decreased by about 1 point during the follow-up period in the DCM group, but rose 1.7 points in the group receiving EUC.
“Why might monthly telephone contact with a mental health clinician benefit women with childhood sexual abuse significantly more than nonabused depressed postpartum women? Women with childhood sexual abuse may have difficulty coping with pregnancy due to the need for intimate examinations and birth, which may trigger traumatic memories,” the authors wrote.
For related information, see the Psychiatric News article “Researcher Discusses Goals and Challenges of Perinatal Mental Illness” and the Psychiatric Services article “Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women.”
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