July 1st, 2017

Depression decreases after intervention

A five-year study, recently published in JAMA Psychiatry, showed that a brief depression intervention could reduce symptoms among mothers by 40 percent. Women with lower depressive symptom levels at the start had even more of a decrease at 61 percent.

Boston Medical Center and collaborator Action for Boston Community Development’s Head Start screened more than 2,200 mothers at Boston-area Head Start locations. A randomized control trial of 230 women compared outcomes for mothers receiving conventional Head Start services and women who got those services and also took part in a six-session program called Problem Solving Education (PSE).

Both groups were followed for a year and assessed for depression over the course of that year.

“The program teaches, in a non-judgmental way, how to take larger, subjective problems and re-think them and re-formulate them into smaller, more objective ones,” said Michael Silverstein, M.D., BMC’s associate chief medical officer for research and population health and the study’s lead author.

“By doing that, the problems become more solvable,” Silverstein said.

“That was sort of the essence of our intervention. PSE is a skills-based intervention on how to re-think problems, but it is also an activation, motivation type program to help people accomplish their own problem-solving goals.”

In addition to problem-solving skills, the intervention included depressive symptom monitoring and participants were referred for additional treatment when necessary.

Silverstein said there was a strict protocol in place to handle participants, who despite the study team’s best efforts, had escalating symptoms or experienced crises. They “tried very hard,” to get those people into formal mental health settings, Silverstein said.

He noted that Boston Medical Center and Head Start have worked on projects together for 14 years and that the national, federally-funded early learning program serves one million low-income families annually.

The U.S. Department of Health and Human Services estimated that depression impacts almost half of Head Start mothers.

“We know that the incidence of depression in mothers is very high and one of the important parts of our project was to deliver preventive care that would be highly culturally competent and something that could be infused into a community-based program that is highly attended by the population with which we were working,” he said.

BMC trained and certified 15 lay people to conduct the intervention.

Because the study showed PSE enrollees having a significant drop in depressive episodes, Silverstein said the next step would revolve around how to take the program and figure out how to implement it under non-study conditions. He would also like to expand its geographic reach.

“It is more evident, that for many individuals, depression is a preventable illness and that building up problem-solving skills and working with community organizations is a very promising way to work on this prevention angle,” Silverstein said.

The study was funded by the National Institute of Mental Health.

By Susan Gonsalves

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