Interpersonal Treatment Program to Prevent Depression and Post-Traumatic Stress Disorder in Low-Income Pregnant Women With Partner Abuse

Each year, approximately 324,000 pregnant women experience partner abuse (PA). With the
emotional highs and lows that accompany new motherhood, pregnancy is often a challenging
process for many women. Experiencing PA, while already going through a vulnerable time
during pregnancy, may have harmful effects on the well-being of the woman and her infant.
Women affected by PA are at an increased risk for certain physical and psychological
problems, including depression and post-traumatic stress disorder (PTSD). Furthermore, the
emotional distress from PA may impair a woman's ability to seek out the necessary support to
ensure the safety of herself and her children. There have been few research efforts to
develop an effective treatment to reduce the psychological impact of PA on pregnant women
and even fewer efforts that target low-income women, who make up a large portion of affected
women. The Reach Out for a Safe Environment (ROSE) program is an interpersonally oriented
treatment developed to address factors that may contribute to postpartum mental health
difficulties associated with PA. This study will evaluate the effectiveness of the ROSE
program in preventing depression and PTSD in low-income pregnant women who have experienced
recent PA.

Participation in this single-blind study will last approximately 29 weeks. All potential
participants will answer an initial questionnaire concerning their history of physical,
sexual, or emotional abuse in the past year. Selected participants will then undergo an
interview about symptoms of depression, reactions to trauma, emotional difficulties, and
alcohol and drug use. Participants invited to continue in the study will then be randomly
assigned to the ROSE program or enhanced care as usual (ECU). Participants assigned to the
ROSE program will attend four weekly 90-minute group sessions prior to delivery and one
individual 50-minute booster session within 4 weeks of delivery. During these sessions,
participants will learn ways to manage stress and negative feelings and how to access
helpful resources. Participants will also complete two questionnaires about emotional
difficulties per week for the duration of the program. Participants assigned to ECU will
receive the usual medical care provided for pregnant women and will receive educational
material on depression.

All participants will complete questionnaires and interviews about their emotional
difficulties, relationships with others, and use of services for these difficulties prior to
treatment assignment, 4 weeks after treatment assignment, 4 weeks after delivery, and 3
months after delivery. Participants in the ROSE program will additionally complete a
questionnaire about their perceptions of the program after the fourth treatment session and
after the booster session.

Inclusion Criteria:

- Able to speak and read English sufficiently to complete the study procedures

- Willing and able to receive public assistance

- Identified as having experienced physical assault based on responses to CTS2 within 1
year prior to study entry

- 35 weeks or less gestation

Exclusion Criteria:

- Meets current criteria for major depressive disorder or post-traumatic stress
disorder