December 16, 2010
Studies show that pregnancy isn't the happiest time in every woman's life.
As a result, an East Carolina University researcher is studying the effectiveness of a program for low-income women in reducing their risk of prenatal, also called antepartum, depression, which is depression that occurs during pregnancy.
Dr. D. Elizabeth Jesse, ECU associate professor of graduate nursing science in the College of Nursing and assistant professor of obstetrics and gynecology in the Brody School of Medicine, has been awarded a National Institute of Mental Health grant that will provide support for pregnant women at risk of depression.
The three-year, $640,742 grant will allow Jesse, a certified nurse midwife, to work with patients at the Pitt County Health Department and ECU Physicians' Regional Perinatal Center. Expectant mothers are already screened for risk of depression, and those with a certain score on the assessment will be invited to enroll in Jesse's study and the program, called Insight Plus.
Each year, up to 50 percent of pregnant women experience depressive symptoms and about 13 percent develop antepartum depression, which can mimic typical pregnancy symptoms from mood swings to fatigue or a change in sleep patterns. Up to 50 percent of women who suffer from antepartum depression also will have postpartum depression, so early intervention is important, Jesse said.
"Women who experience high stress, lack support from family and friends, have lower levels of self-esteem, suffer domestic violence, and think more negatively about themselves can be more at risk for antepartum depression," Jesse said. "They begin to feel sad and useless."
Women often are reluctant to talk about depression during pregnancy or ask for help because of the stigma surrounding it, and they don't want to appear weak or risk being called a "bad mother," Jesse said.
Insight Plus is a culturally tailored intervention to help expectant mothers build emotional support from family and friends, set goals, reduce stress, increase positive thinking and improve self-esteem. It includes spiritual-related material for those who value it. "It is my theory that by decreasing risks and increasing resources these women will improve," Jesse said.
Those enrolled in the program will meet once a week for six weeks with a social worker and a lay assistant, called a "resource mom." The social worker, resource mom and women will work together to identify and solve problems. Transportation and child care will be offered. Each woman will receive an MP3 player programmed with relaxation and stress reduction exercises and other homework assignments, called positive affirmations, Jesse said.
"Should the Insight Plus program prove to be feasible and effective, it will be a model for delivering care by public health staff and lay helpers," Jesse said.
The NIH review panel said findings from the study will be highly relevant for public health because the intervention is integrated within rural prenatal clinics, including the local health department, where access to mental health resources for treating and preventing antepartum depression is limited. The panel also said the intervention is sensitive to the cultural needs of low-income African-American, Caucasian and Hispanic women, a population that has been underrepresented in previous studies.
Co-investigators at ECU are Dr. Melvin Swanson, professor of nursing; Dr. Sheila Bunch, professor of social work; and Dr. Edward Newton, chair and professor of obstetrics and gynecology. Jesse also will collaborate with colleagues at the University of North Carolina at Chapel Hill, Vanderbilt University and the University of Virginia.
ECU offers the only nurse midwifery curriculum in North Carolina. A special intent is for graduates to assume care provider roles in rural areas to meet the needs of underserved women and infants.