Postpartum depression (PPD) affects approximately 13% of women, contributing to poorer
overall maternal psychological health, as well as adverse infant health, behavior, and
emotional development. Women with a history of depression are 21 times more likely to
experience PPD, which most commonly occurs within 4 weeks of delivery. Intervening in
pregnancy to prevent the onset of perinatal mental health disorders can ameliorate these
adverse outcomes and contribute to significant cost savings at $32,300/affected woman.
Despite evidence-based prenatal preventive mental health services for depression, there
are barriers to access, and these services do not offer the adjunctive benefits provided
by yoga-based interventions, including shorter labor duration and increased likelihood of
vaginal birth. Yoga interventions during pregnancy have been shown to significantly
improve depressive symptoms in pregnancy. Yet, previous work examining prenatal yoga was
not prevention-focused; prior studies of prenatal yoga for depression have only examined
treatment for women with current depression or did not evaluate PPD. Because nearly half
of women with a history of depression who develop PPD did not exhibit depressive symptoms
in pregnancy, it is important to include this high-risk group in preventive
interventions.
Yoga is more beneficial than other physical activity interventions for depression
symptoms, including fatigue and stress, and PPD interventions yield greater benefits with
targeted populations. Specifically, yoga may prevent PPD through embodiment-facilitated
improvements in body image and increasing mindfulness. Yet, there are several gaps in
examining effectiveness of yoga for preventing PPD: 1) although racial/ethnic minority
women have higher rates of PPD than White women, they are significantly less likely to
initiate treatment for PPD; yoga interventions may be more engaging; 2) generalizability
of previous studies of prenatal yoga for depression have also been limited by excluding
women with particular psychiatric disorders and/or excluding women already practicing
yoga. Expanding this evidence-based practice to women vulnerable to developing PPD (i.e.,
those with a history of depression) within a health care system may be effective for
engaging high-risk women in a preventive intervention to decrease the risk of PPD. The
proposed study focuses on preventing PPD and improving generalizability by delivering a
virtual prenatal yoga intervention for at-risk, racially diverse women in a health care
system.
The proposed study seeks to pilot test the effectiveness of an adapted evidence-based,
virtually-delivered 8-session group prenatal yoga pilot preventive intervention for women
at high risk of PPD (i.e., history of depression) to assess onset and evaluate factors
which influence implementation within a health care system. The intervention incorporates
evidence-based integrated yoga with mindfulness and embodiment techniques (i.e., proposed
mechanisms). The investigators will also promote the inclusion of individuals of
racial/ethnic minority status in yoga interventions by assessing strategies for inclusion
of these individuals from patient stakeholders. Pregnant participants with a history of
depression will be recruited from Henry Ford Health (HFH), a metropolitan health system
that delivers prenatal care for diverse women (29% non-Hispanic Black). The inclusion of
patient, provider, and administrative stakeholders will inform recruitment, engagement,
and delivery of the intervention, facilitating scalability and sustainability by
assessing barriers and facilitators to implementation.
The specific aims are to:
- Optimize a yoga intervention to prevent PPD within a healthcare system.
1.a. Examine facilitators and barriers of implementation. Conduct 3 focus groups with
patient (n=6-10 pregnant women in each group with a history of depression) and
qualitative interviews administrative (n=10-15 HFH women's health clinicians and
administrators) stakeholders to assess logistics, engagement of racially/ethnically
diverse women with a history of depression, and sustainability of the intervention.
Phenomenological analyses will be used to analyze qualitative findings to increase
patient-centeredness.
b. Optimize delivery. An open trial of pregnant women (n=14) will aid in refining
intervention delivery.
Examine feasibility, acceptability, and satisfaction of the intervention within a
health care system. Pregnant women (n=48) with a history of depression will be
randomized to the intervention (n=24) or treatment as usual (TAU; n=24). Feasibility
will be assessed by measuring enrollment, retention across follow-up time points,
and engagement (e.g., attendance at yoga sessions) rates. A post-intervention survey
will measure acceptability and satisfaction. The investigators hypothesize that the
intervention will be effective for engaging racial/ethnic minorities and that there
will be representative enrollment rates of these groups.
Evaluate effectiveness of the intervention on PPD and proposed mechanisms.
Participants will complete measures of depression, embodiment, and mindfulness at
baseline, post-intervention, and 1 and 3 months post-delivery. The investigators
anticipate that the intervention group will have lower rates of PPD (primary
outcome) at each follow-up time point, higher levels of mindfulness and embodiment
(i.e., proposed mediators; a path), and that these mediators will be associated with
reduced likelihood of PPD (b path).