|
Click on one of the links below to read more about our current research projects.
- Placebo Controlled Trial of Sertraline and IPT for Postpartum Depression
- Clinician Managed Interpersonal Psychotherapy for Postpartum Depression
- Fundamentals of Interpersonal Psychotherapy
- Play Study
- Emotional Experiences of the Partner after Childbirth
- Promoting Wellness for Perinatal Women
- Pregnancy and Postpartum Depression Services
- Supportive Listening With Depressed Low-Income Mothers (Listening Visits)
- Train-the-Trainer: Maternal Depression Screening
- The Acceptability of Nurse Delivered Counseling: Nurses and Women's Views
- Prenatal Maternal Distress and Reproductive Outcomes
- The Family Activity and Behavior Study (FABS)
- Neuropsychological Assessment of Decision Making in Binge Drinking College Students
Placebo Controlled Trial of Sertraline and IPT for Postpartum Depression (ZIP)
The overall aim of this project is to determine the most efficacious treatment for women with PPD. We plan to conduct a randomized clinical trial with 300 outpatients diagnosed with PPD. The study is being conducted at Brown University as well as the University of Iowa. We hypothesize that sertraline and IPT will both be superior to placebo over the course of the 12 week acute treatment trial, and that sertraline will be superior to IPT for the treatment of postpartum anxiety.
We are also planning secondary studies including an investigation of the impact of postpartum depression and treatment on infant psychophysiology; a genetics study of postpartum depression, and a secondary treatment study investigating mother-infant interventions. We are currently recruiting for the study.
For more information about this project, please contact Scott Stuart, M.D., Research Director.
Clinician Managed Interpersonal Psychotherapy for Postpartum Depression (CM-IPT)
The Clinician-Managed Interpersonal Psychotherapy (CM-IPT) for postpartum depression treatment trial is designed to simulate the delivery of IPT in a community setting. Timing and frequency of sessions are determined collaboratively by the therapist and patient rather than specified by a manual. We are evaluating the effectiveness of 12 sessions of CM-IPT delivered over the course of a year compared to “standard” IPT for postpartum depression, a treatment which we have previously demonstrated to be efficacious compared to a waiting list control condition. Secondary aims are to demonstrate the acute effectiveness of CM-IPT for postpartum depression, and to examine relapse rates. Recruitment for the study is complete.
For more information about this project, please contact Scott Stuart, M.D., Research Director.
Fundamentals of Interpersonal Psychotherapy
The Fundamentals of Interpersonal Psychotherapy study is a two-phase project to develop an empirically validated internet-based training program in IPT. On completion, therapists will be able to access an e-learning program which will provide interactive instruction in the entire course of IPT. Phase I of the project, the development of an e-learning prototype, has been completed. Development of the entire program (Phase II) is currently underway; during Phase II we will be recruiting therapists from the community to provide feedback about the program and to participate in an investigation of knowledge retention and clinical usage of IPT comparing e-learning, instructor-led training, and self-instruction with a textbook. Recruitment for Phase II is anticipated to begin in the fall of 2008. The study is being conducted in partnership with Behavioral Tech in Seattle, Washington.
For more information about this project, please contact Scott Stuart, M.D., Research Director.
Play Study
The Play Study was developed in collaboration with Professor Grazyna Kochanska to examine children's moral development. More specifically, the purpose of the study is to examine factors that effect children's moral development and children's response to an intervention designed to increase moral development. The portion of the study conducted in the IDCRC includes interviews and questionnaires that examine maternal depression and related psychopathology. Data is collected at three time points: at the beginning of the intervention, directly following the intervention, and three months after the completion of the intervention. We are interested in the effects of maternal psychopathology, and depression in particular, on children's moral development and intervention outcome. This study is in the data collection phase, and participants are currently being interviewed.
For more information about this project, please contact Michael O'Hara, Ph.D., Research Director.
Emotional Experiences of the Partner after Childbirth
Previous research indicates that depression in partners (at least the males) does occur in the postpartum and may be associated with adverse consequences of maternal depression. However, it is unclear how common it is. There is also some evidence to suggest that rates of depression may be increased in partners of women who have postpartum depression. This study looks at the prevalence of depression in partners of postpartum women, as well as how common coexistent depression is within the postpartum couples. Data was collected on partners of postpartum women in the screening phase of the CM-IPT study. After partners completed measures of depression (EPDS, BDI, IDD) and a brief sociodemographic form, they were sent follow-up depression measures and measures of psychosocial and marital functioning (PPAQ, SAS-SR and DAS). Clarifying rates of depression in postpartum partners and coexistent depression within couples will have implications for future work in developing depression screening for women and their partners, as well as treatments for couples and partners during the postpartum. Recruitment for this study is complete.
For more information about this project, please contact Robin Kopelman, M.D., M.P.H.
Promoting Wellness for Perinatal Women
The overall goal of this research program is to carefully examine barriers to and preferences for mental health treatment for perinatal women so that tailored interventions to overcome the modifiable barriers can be developed in partnership with participating women. This study has both a qualitative and quantitative phase. Perinatal women with depressive symptoms (EPDS >12) or a history of depressive symptoms from Title V funded maternal health agencies participated in focus group discussions of experiences and preferences in seeking perinatal depression care. The purpose of the quantitative study is to quantify and generalize barriers and preferences for perinatal depression treatment. Particular emphasis is placed on examining the roles of trust, treatment history, insurance coverage and depression severity. 500 women are being recruited during pregnancy or postpartum and complete measures of depression (EPDS), attachment style, and the “Barriers and Preferences in Depression Care” measure – a questionnaire developed from established survey questions and the focus groups. It is comprised of questions about barriers to care, treatment preferences, decision making, and provider trust, as well as questions about a potential services intervention. We are currently recruiting for this study.
For more information about this project, please contact Robin Kopelman, M.D., M.P.H.
Pregnancy and Postpartum Depression Services
Perinatal depression is a significant public health problem, yet it often goes undetected or untreated. All 26 Title V maternal health contractors across Iowa are required to conduct a depression screening of each participant at intake. The contractors have been required to record whether or not a screening was done. At present, contractors are not required to report scores, but they are expected to act on the results of a positive screening.
The purpose of this project has been to evaluate the current process of screening and referral for perinatal depression in Title V funded maternal health centers. This will give practitioners, policy makers and researchers information about the breakdowns that occur between screening, referral and treatment, and to suggest opportunities to develop community-oriented maternal mental health services and programs in Iowa. Women receiving services and maternal health staff were interviewed in individual and focus group formats. Women participating in interviews also completed an EPDS. Review of chart data pertinent to mental health screening, referral and service use and secondary data analysis using the Women's Health Information System (WHIS) database (maintained by IDPH) are being conducted. Data are being analyzed using both qualitative and quantitative methods. Recruitment for this study is complete.
For more information about this project, please contact Robin Kopelman, M.D., M.P.H.
Supportive Listening With Depressed Low-Income Mothers (Listening Visits)
The purpose of this study is to evaluate the effectiveness and acceptability of listening visits as delivered by American case managers and nurses to low income women who are served by the Healthy Start program. Listening visits are an empirically supported treatment developed for British public health nurses (health visitors) to deliver in the home to mildly to moderately depressed mothers. Because this treatment is suitable for delivery by trusted providers (case managers and nurses), it has the potential to obviate many treatment barriers that prevent women, particularly those who are low-income or ethnic minorities, from accessing treatment.
The effectiveness of listening visits will be evaluated in two research phases that will both be conducted at Healthy Start in Des Moines: an open trial of 20 subjects (2007-2008) and an RCT of 70 subjects (2008-2012). The central hypotheses of the RCT are that listening visits will be significantly more effective than standard case management in reducing depressive symptoms at the end of treatment and that clients and treatment providers will find listening visits to be an acceptable intervention.
For more information please contact Lisa Segre, Ph.D. Principal Investigator
Train-the-Trainer: Maternal Depression Screening
Train-the-Trainer: Maternal Depression Screening, a joint initiative of the Iowa Depression and Clinical Research Center (IDCRC) and the Iowa Department of Public Health, is funded by the Community Empowerment Program of the Iowa Department of Management. The Train-the-Trainer mentoring team includes Drs. Segre, O'Hara, and Gorman at the University of Iowa's IDCRC, who individually and collectively have over 30 years experience in the area of maternal depression.
The objective of TTT is to develop a cadre of trainers across the State of Iowa who will implement depression screening in their programs/agencies and become community educational resources regarding maternal depression. To accomplish this objective the Train-the-Trainer team:
- teaches trainers about perinatal depression and prepare them to teach others including their program staff and the staff of other interested community programs
- assists trainers and supervisors in developing a screening protocol that is tailored to their program
- provides ongoing consultation to trainers and supervisors with regard to the implementation of maternal depression screening in their programs
Train-the-Trainer #1 and #2 have already certified 31 trainers across Iowa who are now implementing depression screening in their programs and serve as educational resources about maternal depression to their communities. There are 18 trainees in our current program (TTT #3) who will be certified in May, 2008.
This model of implementing/disseminating maternal depression screening is currently being evaluated. Outcome variables include: the number and distribution of trainers across the State of Iowa, trainers' evaluation of the program, the evaluations of the trainers' trainers, and the extent to which screening is implemented in the program.
For more information please contact Lisa Segre, Ph.D. Principal Investigator
The Acceptability of Nurse Delivered Counseling: Nurses and Women's Views
Although puerperal depression is common and the negative effects of depressive symptoms on the well being of the mother and child are well established, depression in pregnant and postpartum women is under-identified and therefore under-treated. The U.S. system of identification and treatment services primarily relies on professional health and mental health services, a venue that poses numerous barriers, particularly for low-income and minority women. Nurse-delivered maternal depression screening and counseling is a model with empirical support in the U.K. that obviates many of these barriers. The British National Health Service (NHS) mandates that every woman receive an in-home postpartum visit from a health visitor, a bachelor's level public health nurse who provides routine postpartum healthcare for mothers and children. Although depression screening and counseling by health visitors is not mandated, health visitors in approximately 85% of health trusts (geographic regions of service delivery in Great Britain) provide these mental health services.
In the U.S., nurses also have ongoing contact with new mothers in several healthcare settings: ob-gyn office, maternity unit, and pediatric units and are thus well positioned to provide these services. Although nurse-delivered counseling shows promising empirical support, little is known about whether this model of care is acceptable to American nurses (the potential treatment providers) or women (the potential treatment recipients). Three survey studies have been conducted to assess their views.
Study 1, using a convenience sample generated from the mailing list of the Iowa Board of Nurses (n= 520), assessed nurses views of the acceptability of nurse-delivered screening and counseling. Women's views were assessed in Studies 2 and 3. The participants in Study 2 (n= 691), who were recruited in the screening phase of the CM-IPT study, were primarily white and middle to upper income. A third survey was therefore conducted in Healthy Opportunities for Parents to Experience Success Healthy Families Iowa program (HOPES-HFI) to assess the views of lower income and ethnic minority women about this model of care (n=131).
For more information please contact Lisa Segre, Ph.D. Principal Investigator
Prenatal Maternal Distress and Reproductive Outcomes (PNMS Study)
The primary goal of this study is to examine the association between maternal distress during pregnancy, defined as stress, anxiety, and depression, and maternal and infant reproductive outcomes including obstetric complications, infant birth weight, and preterm delivery. It is hypothesized that women who report high levels of distress during pregnancy will be more likely to experience these adverse outcomes. An additional goal of this study is to examine the hypothesis that women who report high levels of distress during pregnancy, but who have adequate social support and have effective coping skills, will be less susceptible to the detrimental effects of distress.
This study utilizes a prospective, longitudinal design. Three hundred pregnant women receiving prenatal care clinics will complete packets containing questionnaires assessing sociodemographic factors, maternal distress, social support, and coping at two points during pregnancy. At each assessment point, women also participate in structured telephone interviews to assess symptoms of common psychological disorders. Following delivery, information regarding obstetric complications, birth weight, week of delivery, APGAR score, and other health information will be extracted from medical records. It is our hope that an understanding of potential risk and protective factors will inform interventions to prevent adverse reproductive outcomes.
For more information about this project, please contact Kim Nylen, Research Director.
Postpartum Blues: A Prospective and Factor Analytic Study (PPB)
The postpartum blues is a common and predictable phenomenon that may offer insight into the etiology of women's mood disorders in general. The blues typically occurs within 7-10 days immediately following childbirth. Symptoms include mood lability, crying, irritability, dysphoria, and elation and usually reach a peak of intensity between days 3-5 postpartum. Previous research findings on the blues have been inconclusive, mainly due to lack of a well established symptom structure and little agreement on its precise definition. Thus, the purpose of this study is to examine the symptom structure of a daily mood questionnaire designed to assess the blues, and to further investigate symptoms and their pattern of change over 10 consecutive days postpartum. We hypothesize that a two-factor solution will best represent the daily mood data, intensity of negative mood symptoms will peak between days 3-5 postpartum, and that a greater intensity of negative mood symptoms will be associated with depression/neuroticism as well as clinical diagnoses of the blues at 2 weeks postpartum. We aim to recruit 300 recently delivered mothers from the maternity ward at the University of Iowa Hospitals and Clinics (UIHC). Recruitment and data collection for the study are currently underway.
For more information about this project, please contact Melissa Buttner.
The Family Activity and Behavior Study (FABS)
The main focus of the Family Activity and Behavior study is to examine parental involvement in families with an approximately 3 ½ year old child from a community sample. Parental depressive symptoms are hypothesized to have negative effects on child behavior problems and martial satisfaction. Low marital satisfaction is also expected to correlate to child behavioral problems. We hypothesize that marital satisfaction will be a mediator between parental depressive symptoms and child behavioral problems. In addition, father's playful parent-child activity is predicted to buffer the target child from the negative effects of maternal depression. We plan to collect data from 200 families in Iowa and are currently recruiting participants.
For more information about this project, please contact Sheehan D. Fisher.
Neuropsychological Assessment of Decision Making in Binge Drinking College Students
Impaired decision making is an accompaniment of chronic alcohol use; the ventromedial prefrontal cortex (VMPFC) appears to be the brain structure associated with this impairment. Studies using the Iowa Gambling Task (IGT), a behavioral measure of VMPFC functioning, have demonstrated that substance dependent individuals make more errors on the gambling task than non-substance dependent individuals. However, little research has explored IGT performance in non-clinical populations. Given the negative health and behavioral consequences experienced by frequent binge drinking college students, it makes sense to consider VMPFC functioning in this population. The present study addressed this issue by comparing performance on the IGT and the Cups Task, which examines whether participants' decision making abilities differ depending on consideration of potential gains or potential losses, in a sample of undergraduate binge-drinkers and non-binge drivers.
For more information about this project, please contact Dana Figlock, M.A., Primary Investigator.
|
