Interpersonal Psychotherapy for Women with Depression Living on Low Incomes
NANCY K. GROTE, HOLLY A. SWARTZ, AND ALLAN ZUCKOFF
Individuals of low socioeconomic status (SES) have higher prevalence rates of major depression than the general population (DHHS, 1999, 2001 ; Kessler et al., 2003; Lorant et al., 2003; McMillan et al., 2010; Williams & Collins, 1995). A meta-analysis by Lorant et al. (2003), based on fifty-six studies, showed that individuals with low SES had a higher risk of major depression or clinically significant depressive symptoms than individuals with high SES, and this association was not limited to the bottom SES group but persisted across the social spectrum. This meta-analysis measured SES by education, income, or work status.
Although the association between SES and major depression applies across genders, this chapter focuses on women with depression living on low incomes, who face significant barriers to treatment access, engagement, and retention. Women are twice as likely as men to experience a lifetime episode of major depression (Weissman & Klerman, 1977; Wolk et al., 1995). High levels of depressive symptoms are common in young minority women (Kessler et al., 1994) and in pregnant and postpartum mothers and mothers on low incomes: 20% to 25% meet criteria for major or minor depression (Hobfall et al., 1995; Miranda et al., 1998; 2003; Scholle et al., 2003; Siefert et al., 2004) compared to 9% to 13% of their middle-income peers (Gotlib et al., 1991; O’Hara & Swain, 1996).
Despite this increased risk for and prevalence of depression in low-income women (DHHS, 1999; Perez-Stable et al., 1990), many either do not seek mental health services or drop out after an initial visit or after their acute distress abates (Greeno et al., 1999; Miranda et al., 1998; Leaf et al., 1985; Sue et al., 1991). In the National Comorbidity Survey replication, Wang et al. (2005) found that most people with mental disorders, especially those from racial/ethnic minorities and those on low incomes, either remain untreated or receive minimal, inadequate treatment. Thus, failure to engage and retain low-income and minority individuals with depression in efficacious mental health services constitutes a critical public health problem (DHHS, 1999,2001).
In this chapter, we review the effectiveness of IPT for depressed women on low incomes and highlight the multiple chronic stressors and barriers to care they face. We describe adaptations and additions to IPT we have made in our work with depressed, low-income women who face practical, psychological, and cultural barriers to treatment engagement and retention. A case example demonstrates these modifications in the delivery of IPT.