Dlin/Fischer Clinical Research Award: The PRogram in Support of Moms (PRISM): Results of A Cluster Randomized Controlled Trial of Two Active Interventions Addressing Perinatal Depression in Ambulatory Obstetric Settings

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Room 217

Presenting Author(s)

Nancy Byatt, DO, DFAPA, FACLP (she/her/hers)

Professor with Tenure, Psychiatry, Ob/Gyn, and Population and Quantitative Health Sciences
Umass Chan Medical School
Shrewsbury, Massachusetts

PDF

Co-Author(s)

Linda Brenckle, MS

Project Director
UMass Chan Medical School
Shrewsbury, Massachusetts
PS

Padma Sankaran

Research Project Director
UMass Chan Medical School
Frisco, Texas
JF

Julie Flahive, MS

Biostatistician
University of Massachusetts Chan Medical School
Worcester, Massachusetts
JK

Jean Ko, PhD

Team Lead, Maternal Health and Chronic Disease Team
Centers for Disease Control and Prevention
Atlanta, Georgia
CR

Cheryl Robbins, PhD

Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Martha Zimmermann, PhD

Post-doctoral Associate
University of Massachusetts Chan Medical School
Shrewsbury, Massachusetts
Jeroan Allison, MD, MdEpi

Professor & Chair
UMass Chan Medical School
Worcester, Massachusetts
Sharina Person, PhD, PhD

Professor and Vice Chair
University of Massachusetts Chan Medical School
Worcester, Massachusetts
Tiffany Moore Simas, MD, MPH, MEd, FACOG

Chair & Professor, Department of Obstetrics & Gynecology
UMass Chan Medical School/UMass Memorial Health
Upton, Massachusetts

2022 Dlin/Fischer Clinical Research Award Winner

Objective: We compared the effectiveness of two active interventions for perinatal depression.

Methods: We conducted a cluster randomized controlled trial. Ten Ob/Gyn practices were randomly assigned to receive (1) the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a state-wide, population-based program, and (2) the PRogram In Support of Moms (PRISM) which includes MCPAP for Moms plus a proactive, multifaceted, obstetric practice-level intervention with intensive implementation support. Patient participants (n=312) with Edinburgh Postnatal Depression Scale Scores (EPDS) ≥ 10 were recruited from participating practices and followed up to 11-13 months postpartum. Differences in depression symptomatology and treatment participation among patient participants were compared by intervention group. Generalized estimating equations were used to examine treatment initiation in MCPAP for Moms versus PRISM.

Results: EPDS scores decreased by 4.5 in the MCPAP for Moms groups and 4.7 points in the PRISM group at 11-13 months postpartum as compared to baseline. Treatment initiation rates were 57% in the PRISM group and 50% MCPAP for Moms group. No statistically significant differences in depression symptomatology or treatment initiation were found between the groups. However, 32% of patient participants in the PRISM group sustained treatment compared with 22% in the MCPAP for Moms group.

Conclusion: Both MCPAP for Moms and PRISM are effective in improving depression symptomology, and treatment initiation and sustainment rates. This finding is important because 1) 4-point decrease in EPDS is clinically significant, and 4) MCPAP for Moms was equally as effective as PRISM but is lower intensity and has greater population-based reach.