(925) Do Adverse Perinatal Events Moderate Response to Behavioral Activation Psychotherapy: Findings from the SUMMIT Trial

Objective:
Adverse perinatal events (APE) are associated with maternal depression, anxiety, and trauma symptoms. However, it is not known whether APE modify the effectiveness of behavioral activation (BA) to treat perinatal mood disorders.

Study Design:
BA delivered to perinatal participants in the Scaling Up Maternal Mental Healthcare by Increasing Access to Treatment (SUMMIT) trial significantly reduced depression (EPDS), anxiety (GAD-7) and trauma (PCL-6) measured at 3-months post-treatment. In this secondary analysis, 12-month mood outcomes were used to compare participants with and without one or more APE (pre-eclampsia, operative vaginal delivery, unplanned cesarean, emergency cesarean, excessive bleeding, blood transfusion, NICU admission, and fetal loss). Chi-square and T-Tests were performed along with MANCOVA to further evaluate APE’s influence on BA efficacy after controlling for relevant covariates (age, marital status, education, race/ethnicity, immigration status, treatment dosage, provider type, treatment modality, nulliparous status, perceived social support, participant satisfaction and baseline symptom scores).

Results:
519 (46%) of the 1119 participants had >1 APE and their 12-month mood scores were compared to the 600 non-APE cases (Table). Clinical symptom scores were statistically significant and worse in all groups (EPDS, GAD-7 and PCL-6; p< 0.05) among those participants with APE versus non-APE. However, absolute score differences did not appear to be clinically meaningful (i.e., < 2 units for each APE versus non-APE comparison). In addition, similar proportions of APE and non-APE subjects had scores in the normal screening range, respectively (EPDS < 10, 57.4 vs. 62.3; GAD-7 < 10, 77.2 vs.79.3; PCL-6 < 14, 57.3 vs. 60.0).

Conclusion:
While APE do appear to influence peripartum BA treatment responsiveness for symptoms of depression, anxiety, and trauma, the effect appears modest and should not preclude BA’s application in these patients.