RESEARCH ON IPT WITH WOMEN WITH DEPRESSION LIVING ON LOW INCOMES
Promising evidence for the effectiveness of IPT in this population has emerged from 11 studies specifically treating depressed, socioeconomically disadvantaged women. Although IPT was sometimes shortened and, in many studies, flexibly delivered—on the telephone, in the home, in prison, or in a destigmatizing setting such as a prenatal clinic or a school health class—most of these studies provide little information (except Beeber et al., 2008, and Talbot & Gamble, 2008) about how the researchers adapted IPT to address psychological or cultural barriers to care, including the culture of poverty and race/ethnicity. Two open trials and three randomized controlled trials focused on women with a depressive disorder or symptoms and other psychiatric comorbidities (e.g., an anxiety disorder or substance abuse), psychosocial vulnerabilities (e.g., imprisonment, immigrant status), or medical illness (HIV-AIDS). Acute IPT sessions lasted fifty to sixty minutes, unless otherwise specified.
Talbot et al. (2005) conducted a pilot open trial of sixteen sessions of IPT in a community mental health center with twenty-five socioeconomically disadvantaged women with major depression who reported childhood sexual abuse. Most had a comorbid anxiety disorder, such as PTSD. Talbot and Gamble (2008) described how IPT was modified to accommodate the stressful lives of the women in the sample who were living on low incomes. Modifications included an expanded treatment duration (from sixteen to thirty-two weeks to increase treatment participation) and an engagement analysis in initial IPT sessions to help patients overcome social and practical barriers to care. Significant improvements in depression and psychological functioning, but not social functioning, were observed at ten, twenty-four, and thirty-six weeks after baseline. In another open trial (Johnson & Zlotnick, 2008), twenty-five female prisoners with depression or dysthymic disorder and at least one substance abuse disorder, who were enrolled in a substance abuse treatment program, received twenty-four sessions of an interpersonally based group intervention over eight weeks. Group IPT was adapted to address the treatment needs of female prisoners, including addressing substance use-specific social support and communication problems, interpersonal consequences of sexual and physical assaults, disrupted family and friendship relationships resulting from women’s entry into or attempted exit from drug- or crime-involved lifestyles, and reactions to loss or potential loss of children to the child welfare system. Prison substance use counselors who received IPT training co-led the group treatment. At post-treatment, depressive severity and perceived social support had improved, and 75% of participants no longer met criteria for any depressive disorder.
A small randomized trial (Ransom et al., 2008) treating seventy-nine rural, financially disadvantaged individuals (84% male) with major depression or dysthymia and an HIV-AIDS diagnosis showed that six sessions of telephone-delivered IPT significantly reduced depressive severity and psychiatric symptoms compared to usual care. Clinically meaningful change (Jacobson & Truax, 1991) in depressive symptoms was higher in the IPT group (23%) than in the usual care group (9%).
Beeber et al. (2004, 2010) conducted two randomized trials for Early Head Start mothers with depressive symptoms, providing eight IPT sessions in the 2004 trial (n = 16 African-American and white, non-Hispanic mothers) and eleven IPT sessions in the 2010 trial (n = 80 new immigrant Latina mothers with limited English fluency) of nurse-delivered, in-home, culturally tailored IPT (plus five follow-up booster sessions) or usual care (no therapeutic intervention until data collection completed). IPT mothers showed significantly greater decrease in depressive symptoms (1) at eight and sixteen weeks after baseline in the 2004 trial and (2) at posttreatment and four weeks post-treatment in the 2010 trial. At four weeks post-treatment, more IPT mothers (78%) than usual-care mothers (53%) scored below the depression cutoff of 16 on the CES-D (Center for Epidemiology Studies- Depression; Radloff, 1977). Beeber et al. (2008) described culturally enhancing IPT in their 2010 trial by partnering with bilingual Early Head Start staff who screened Latina women for the study using the CES-D Spanish version, provided Spanish translation during treatment sessions in a destigmatizing home setting, and assisted the women in meeting their survival needs, such as obtaining housing, food, transportation, health care, and resources for their children’s schooling.
Six studies (two open trials, four randomized controlled trials) of IPT with low- income, pregnant women at risk for or having a depressive disorder yielded positive results. An open trial (Miller et al., 2008) treated eleven predominantly financially disadvantaged, pregnant adolescents with major depression in an urban public school with twelve sessions of group IPT. Depressive symptoms significantly decreased: at post-treatment 73% no longer met criteria for major depression. These gains were maintained at the two-week postpartum follow-up. In two trials of thirty- seven and ninety-nine financially disadvantaged women receiving care in a prenatal clinic who were at risk for postpartum depression, Zlotnick et al. (2001, 2006) randomly assigned subjects to receive four ninety-minute sessions of IPT-oriented group intervention, entitled ROSE (Reach Out, Stand strong, Essentials for new mothers), in addition to standard antenatal care. ROSE subjects were significantly less likely than those receiving standard antenatal care alone to develop postpartum depression within three months after delivery (2001 study: 0% vs. 33%; 2006 study: 4% vs. 20%). The 2006 study found no group differences in depressive severity three months postpartum. Similarly, in a small randomized controlled trial, Crockett, Zlotnick, et al. (2008) reported that thirty-six low-income, rural African-American pregnant women at risk for postpartum depression who received the ROSE intervention showed better adjustment three months postpartum than the usual care group, but there were no group differences in depressive severity.
Finally, an open trial (n = 13) and a small randomized controlled trial (n = 53) by Grote et al. (2004, 2009) supported the effectiveness of brief IPT (eight sessions, plus a pre-therapy “engagement” session) and monthly maintenance IPT (until six months postpartum) in reducing antenatal depression diagnoses and depressive symptoms and improving social functioning for socioeconomically disadvantaged, pregnant, depressed women. Because most women in both trials reported childhood trauma and recurrent depression, which are risk factors for depressive relapse (Frank et al., 1993), IPT maintenance sessions to prevent depressive relapse were an integral part of the 2009 trial design. In the latter study, 68% of the brief IPT group received an average of six IPT maintenance sessions. In the 2004 open trial, brief IPT significantly reduced depressive severity and major depression diagnoses at post-treatment (from 83% to 0%) and six months postpartum (from 83% to 8%). In the 2009 study, more women in brief IPT than in usual care showed a 50% improvement in depressive severity post-treatment (80% vs. 21%) and six months postpartum (88% vs. 25%), and fewer women in brief IPT than usual care met criteria for major depression post-treatment (5% vs. 42%) and six months postpartum (0% vs. 30%). Grote et al. (2004, 2009) enhanced IPT to make treatment relevant for the cultures of poverty and race/ethnicity and to address treatment ambivalence and barriers to care.