Postpartum depression (PPD)-i.e., depression in the first postnatal year-affects 10-20%
of women and is associated with diminished functioning, impaired interpersonal
relationships, decreased parenting self-efficacy and less responsive parenting. Immigrant
Latinas living in the United States are disproportionately affected by PPD, with rates
estimated between 30-42%. Hypothesized mechanisms for this excess risk include
acculturative stress, high rates of trauma, poverty, discrimination, and limited social
support. Unfortunately, PPD prevention and treatment is limited among immigrant Latinas
due to structural and cultural factors including lack of insurance, competing demands,
shortages of language-concordant providers, and stigma. These factors underscore not only
the need for interventions to reach this population, but also the need to deliver
interventions outside of traditional healthcare settings.
Mothers and Babies (MB) is a group-based cognitive-behavioral intervention designed to
teach mood regulation skills to women at risk for PPD. Originally developed for women of
Latin American descent, the United States Preventive Services Task Force recognized MB as
one of the two most effective counseling interventions for PPD prevention, with moderate
to large effects sizes found across a series of randomized controlled trials (RCTs). MB
has shown consistent positive effects when delivered to women across different
racial/ethnic groups, including immigrant Latinas. However, prior MB trials with
immigrant Latinas have found variability in dosage received, resulting in weaker
intervention effects for individuals less fully engaging with the intervention. Previous
MB trials also did not explicitly address social determinants of health such as food
insecurity that may mitigate intervention effects. Immigrant Latinas have found the group
modality highly effective in decreasing isolation and expanding access to resources and
social networks, thus suggesting a potential larger role for group intervention
modalities to address key social determinants of health.
This R01 application builds on previous trials of the MB in-person group intervention
with immigrant Latinas by examining the effectiveness and implementation of virtual
delivery of MB ("Mothers and Babies Virtual Group"; MB-VG). No prior studies have
examined the effectiveness of a virtual group-based intervention to prevent PPD. Virtual
interventions have the potential to mitigate structural barriers to receipt of mental
health services commonly experienced by immigrant Latinas, thereby enabling increased
intervention dosage. Virtual platforms can also facilitate delivery of multidisciplinary
content by off-site providers that address inter-related social determinants of health
that may moderate intervention impact. As such, the Investigators developed and
pilot-tested MB-VG, modifying content of the in-person MB group intervention for virtual
delivery, incorporating content focused on social determinants of health and parenting
delivered by external service providers, and incorporating text messages as an
implementation strategy to reinforce intervention content and promote intervention
engagement. Pilot testing with 30 immigrant Latinas enrolled in three family support
centers (Judith P. Hoyer Early Learning Hubs, "Judy Centers") in Maryland demonstrated
good feasibility and acceptability of MB-VG. Investigators also found small to medium
effect sizes demonstrating MB-VG effectiveness in reducing depressive symptoms and
parenting stress and improving self-efficacy to manage emotions. The investigators are
now poised to test MB-VG in a rigorous RCT and propose to conduct a Type 1
Effectiveness-Implementation RCT that enrolls 300 perinatal women (150 MB-VG; 150
controls receiving usual family support services) from across 12 Judy Centers with the
following Specific Aims:
Aim 1: To examine MB-VG effectiveness with perinatal immigrant Latinas at risk of PPD.
Women receiving MB-VG will exhibit greater reductions in depressive symptoms (Hypothesis
1; H1), exhibit fewer cases of PPD (H2) and report increased parenting self-efficacy and
responsiveness (H3) compared to control participants receiving usual family support
services. Exploratory Aim: Amongst enrolled participants (n~150) who have an older child
aged 2.5-4.5 years, the study will examine whether the skills taught in MB-VG also
promote less child dysregulation and greater child readiness for school.
Aim 2. To evaluate MB-VG implementation. To inform future intervention delivery and
scalability, the study will assess key implementation outcomes. Guided by the RE-AIM
framework, mixed methods will be employed (e.g., semi-structured interviews, survey data,
and session audio-recordings) to assess MB-VG reach, adoption, implementation, and
maintenance.
Aim 3. To examine contextual factors influencing MB-VG effectiveness and implementation.
Guided by the Consolidated Framework for Implementation Research (CFIR), the study will
measure contextual factors at the outer (e.g., participant needs/resources), inner
(organizational characteristics), actors (facilitators), intervention and implementation
process (virtual) levels via mixed methods.