Effects of M-DEPTH Model of Depression Care on Maternal Functioning and Infant Developmental Outcomes in the Six Months Post-Delivery: Results From a Cluster Randomized Controlled Trial

AbstractPerinatal depression has been shown to have deleterious effects on maternal postpartum functioning as well as early child development. However, few studies have documented whether depression care helps to mitigate these effects. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual problem solving therapy) on maternal functioning and infant development in the first 6 months post-delivery in an ongoing cluster randomized controlled trial of 391 HIV-infected women with at least mild depressive symptoms enrolled across eight antenatal care clinics in Uganda. A subsample of 354 (177 in each of the intervention and control groups) had a live birth delivery and composed the analytic sample, of whom 69% had clinical depression at enrollment; 70% of women in the intervention group (including 96% of those with clinical depression) received depression treatment. Repeated-measures multivariable regression models found that the intervention group reported better infant care, lower parental burden, and greater perceived adequacy of parental support, compared to the control group. These findings suggest that depression care for pregnant women living with HIV is important not only for maternal mental health but also because it helps women to better manage parenting and care for their infant.Keywords: Perinatal depressionmaternal functioninginfant developmentUgandaHIVproblem solving therapyantidepressant therapydepression care AcknowledgementWe acknowledge the contribution of our study coordinators: Alice Namuganda, Rose Kisa, and Mercylynn Agasha, who were responsible for participation recruitment, all data collection, and protocol coordination, and Mahlet Gizaw, who was responsible for data management. We thank the peer mothers and midwife nurses at each site for their efforts in implementing depression care and screening. Last, we thank all the women who agreed to participate in the study.Authors’ ContributionsAll authors contributed to the study conception and design. Material preparation and data analysis were performed by BGD and GW. The first draft of the manuscript was written by Wagner, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.Ethics ApprovalApproval was obtained from the institutional review boards at RAND and Makerere University School of Public Health, and the Uganda National Council for Science and Technology. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.Informed ConsentWritten informed consent was obtained from all individual participants included in the study.Disclosure StatementNo potential conflict of interest was reported by the author(s).Data Availability StatementDe-identified dataset and statistical code are available to researchers upon submission of proposal and review by the study team.Additional informationFundingThe study was supported by funding from National Institute of Mental Health [grant R01MH115830; PI: Wagner].