Richard Neugebauer, PhD; Jennie Kline, PhD; John C. Markowitz, MD; Kathryn L. Bleiberg, PhD; Laxmi Baxi, MD; Mark A. Rosing, MD, MPH; Bruce Levin, PhD; and Jessica Keith, MA
Objective: Miscarriage, which occurs in 10% to
20% of clinically recognized pregnancies, is associated with an
increased risk for subsyndromal depression. We examined whether
Interpersonal Counseling (IPC) was superior to treatment as usual
(TAU) in reducing subsyndromal depression among miscarrying women
and, secondarily, superior to TAU in improving role functioning.
Method: Nineteen of 20 eligible women
participated in a randomized controlled trial of 1 to 6 weekly
telephone sessions of IPC versus TAU, which consisted of whatever
lay counseling or professional care women sought on their own
initiative, from October 2001 to April 2002. The 2 trial arms
were compared on mean within-subject change in Hamilton Rating
Scale for Depression-17-item (HAM-D-17) scores and in role
functioning scale scores (a 5-item modification of the 36-item
Medical Outcomes Study questionnaire) from baseline to
post-intervention.
Results: In the primary intent-to-treat
analysis, the baseline mean HAM-D-17 scores were 18.0 (SD ± 8.4)
and 14.8 (SD ± 6.6) in the IPC (N = 10) and TAU (N = 9) arms,
respectively; post-intervention, the corresponding means were
11.6 (SD ± 8.2) and 12.9 (SD ± 8.3). The mean within-subject
decline in HAM-D-17 scores was significantly greater in the IPC
(6.4) than in the TAU (1.9) arm (difference in mean
within-subject score decline, adjusted for design features,
baseline HAM-D-17 scores and for baseline ethnic imbalance
between study arms, 6.2 [95% CI = 0.4 to 12.0]). In a subordinate
completers' analysis (N = 15), the corresponding mean decline and
difference in adjusted mean decline were 8.0, 2.4, and 6.7 (95%
CI = 0.4 to 13.1), respectively. Treatment was unrelated to
improved role functioning.
Conclusion: The efficacy of
telephone-administered IPC for subsyndromal depression after
miscarriage warrants testing in a full-scale randomized
controlled trial.
J Clin Psychiatry 2006;67(8):1299-1304
© Copyright 2006 Physicians Postgraduate Press, Inc.