Effect of Brief Interpersonal Therapy on Depression
简短的人际关系治疗对抑郁症的影响

Visual Abstract  视觉摘要
IMPORTANCE Prenatal depression is prevalent with negative consequences for both the mother and developing fetus. Brief, effective, and safe interventions to reduce depression during pregnancy are needed.
重要性 产前抑郁症很普遍，对母亲和发育中的胎儿都有负面影响。需要简短、有效和安全的干预措施来减轻怀孕期间的抑郁。

OBJECTIVE To evaluate depression improvement (symptoms and diagnosis) among pregnant individuals from diverse backgrounds randomized to brief interpersonal psychotherapy (IPT) vs enhanced usual care (EUC).
目的 评估来自不同背景的孕妇的抑郁改善（症状和诊断），随机接受简短人际心理治疗 （IPT） 与加强常规护理 （EUC）。

DESIGN, SETTING, AND PARTICIPANTS A prospective, evaluator-blinded, randomized clinical trial, the Care Project, was conducted among adult pregnant individuals who reported elevated symptoms during routine obstetric care depression screening in general practice in obstetrics and gynecology (OB/GYN) clinics. Participants were recruited between July 2017 and August 2021. Repeated measures follow-up occurred across pregnancy from baseline (mean [SD], 16.7 [4.2] gestational weeks) through term. Pregnant participants were randomized to IPT or EUC and included in intent-to-treat analyses.
设计、设置和参与者 一项前瞻性、评估者设盲的随机临床试验，即 Care Project，在妇产科 （OB/GYN） 诊所的全科实践中报告症状升高的成年孕妇中进行。参与者是在 2017 年 7 月至 2021 年 8 月期间招募的。从基线 （平均 [SD]，16.7 [4.2] 孕周）到足月的整个妊娠期进行重复测量随访。怀孕的参与者被随机分配到 IPT 或 EUC 组，并被纳入意向治疗分析。

INTERVENTIONS Treatment comprised an engagement session and 8 active sessions of brief IPT (MOMCare) during pregnancy. EUC included engagement and maternity support services.
干预 治疗包括怀孕期间的一次参与会议和 8 次活跃的简短 IPT （MOMCare）。EUC 包括参与和产科支持服务。

MAIN OUTCOMES AND MEASURES Two depression symptom scales, the 20-item Symptom Checklist and the Edinburgh Postnatal Depression Scale, were assessed at baseline and repeatedly across pregnancy. Structured Clinical Interview for DSM-5 ascertained major depressive disorder (MDD) at baseline and the end of gestation.
主要结局和措施 两种抑郁症状量表，即 20 项症状检查表和爱丁堡产后抑郁量表，在基线时进行评估，并在妊娠期间重复评估。DSM-5 的结构化临床访谈确定了基线和妊娠结束时的重度抑郁症 （MDD）。

RESULTS Of 234 participants, 115 were allocated to IPT (mean [SD] age, 29.7 [5.9] years; 57 [49.6%] enrolled in Medicaid; 42 [36.5%] had current MDD; 106 [92.2%] received intervention) and 119 to EUC (mean [SD] age, 30.1 [5.9] years; 62 [52.1%] enrolled in Medicaid; 44 [37%] had MDD). The 20-item Symptom Checklist scores improved from baseline over gestation for IPT but not EUC ( $d=0.57$$d=0.57$d=0.57d=0.57; 95% CI, 0.22-0.91; mean [SD] change for IPT vs EUC: 26.7 [1.14] to 13.6 [1.40] vs 27.1 [1.12] to 23.5 [1.34]). IPT participants more rapidly improved on Edinburgh Postnatal Depression Scale compared with EUC ( $d=0.40$$d=0.40$d=0.40d=0.40; $95\mathrm{\%}\mathrm{Cl},0.06-0.74$$95\mathrm{\%}\mathrm{Cl},0.06-0.74$95%Cl,0.06-0.7495 \% \mathrm{Cl}, 0.06-0.74; mean [SD] change for IPT vs EUC: 11.4 [0.38] to 5.4 [0.57] vs 11.5 [0.37] to 7.6 [0.55]). MDD rate by end of gestation had decreased significantly for IPT participants (7 [6.1%]) vs EUC (31 [26.1%]) (odds ratio, 4.99; 95% CI, 2.08-11.97).
结果在 234 名参与者中，115 名被分配到 IPT（平均 [SD] 年龄，29.7 [5.9] 岁;57 [49.6%] 参加了医疗补助;42 [36.5%] 目前患有 MDD;106 [92.2%] 接受了干预）和 119 名被分配到 EUC（平均 [SD] 年龄，30.1 [5.9] 岁;62 [52.1%] 参加了 Medicaid;44 [37%] 患有 MDD）。IPT 的 20 项症状检查表评分在妊娠期间较基线有所改善，但 EUC 未改善 （ $d=0.57$$d=0.57$d=0.57d=0.57 ;95% CI，0.22-0.91;IPT 与 EUC 的平均 [SD] 变化：26.7 [1.14] 至 13.6 [1.40] 与 27.1 [1.12] 至 23.5 [1.34]）。与 EUC 相比，IPT 参与者在爱丁堡产后抑郁量表上改善得更快 （ $d=0.40$$d=0.40$d=0.40d=0.40 ; $95\mathrm{\%}\mathrm{Cl},0.06-0.74$$95\mathrm{\%}\mathrm{Cl},0.06-0.74$95%Cl,0.06-0.7495 \% \mathrm{Cl}, 0.06-0.74 ;IPT 与 EUC 的平均 [SD] 变化：11.4 [0.38] 至 5.4 [0.57] 与 11.5 [0.37] 至 7.6 [0.55]）。IPT 参与者 （7 [6.1%]） 与 EUC （31 [26.1%]） （比值比，4.99;95% CI，2.08-11.97） 相比，IPT 参与者妊娠结束时的 MDD 率显著降低。

CONCLUSIONS AND RELEVANCE In this study, brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics. As a safe, effective intervention to relieve depression during pregnancy, brief IPT may positively affect mothers’ mental health and the developing fetus.
结论和相关性 在这项研究中，与从初级妇产科诊所招募的来自不同种族、民族和社会经济背景的孕妇相比，与 EUC 相比，简短的 IPT 显着降低了产前抑郁症状和 MDD。作为一种安全、有效的缓解怀孕期间抑郁症的干预措施，简短的 IPT 可能会对母亲的心理健康和发育中的胎儿产生积极影响。

TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCTO3011801
TRIAL REGISTRATION ClinicalTrials.gov 标识符： NCTO3011801

Supplemental content  补充内容

Author Affiliations: Author affiliations are listed at the end of this article.
作者单位：本文末尾列出了作者单位。

Corresponding Authors: Benjamin L. Hankin, PhD, Director of Clinical Psychology, Department of Psychology, University of Illinois Urbana-Champaign, 603 E Daniel St, Champaign, IL 61820 (hankinb@ illinois.edu); Elysia Poggi Davis, PhD, Department of Psychology, 2155 South Race St, University of Denver, Denver, CO 80208-3500 (elysia.davis@du.edu).
通讯作者：Benjamin L. Hankin 博士，伊利诺伊大学厄巴纳-香槟分校心理学系临床心理学主任，地址：603 E Daniel St， Champaign， IL 61820 （hankinb@ illinois.edu）;Elysia Poggi Davis 博士，心理学系，丹佛大学南雷斯街 2155 号，丹佛，科罗拉多州 80208-3500 （elysia.davis@du.edu）。

Depression is common and contributes to disability and disease burden. ${}^1$${}^1$^(1){ }^{1} Approximately $17\mathrm{\%}$$17\mathrm{\%}$17%17 \% of pregnant individuals meet criteria for major depressive disorder (MDD) diagnosis, ${}^2$${}^2$^(2){ }^{2} and up to $37\mathrm{\%}$$37\mathrm{\%}$37%37 \% report elevated symptoms during pregnancy. ${}^3$${}^3$^(3){ }^{3} Prenatal maternal depression confers intergenerational risks, including preterm birth as well as developmental delays, and enhanced vulnerability to psychopathology in offspring. ${}^{4-10}$${}^{4-10}$^(4-10){ }^{4-10} The Perinatal Depression Task Force of the American College of Obstetricians and Gynecologists ${}^{11}$${}^{11}$^(11){ }^{11} highlighted the need for early screening of depression and intervention during pregnancy. Still, most published work and current health care policy has emphasized preventing postpartum depression with scant attention focused on reducing prenatal depression. ${}^{12}$${}^{12}$^(12){ }^{12} With pregnancy as a sensitive period of enhanced vulnerability for both pregnant individuals and the developing fetus, we identified a clear need for a randomized clinical trial (RCT) implemented exclusively during pregnancy with the goal of evaluating a brief, safe intervention to decrease prenatal depression.
抑郁症很常见，并会导致残疾和疾病负担。 ${}^1$${}^1$^(1){ }^{1} 大约有孕妇 $17\mathrm{\%}$$17\mathrm{\%}$17%17 \% 符合重度抑郁症 （MDD） 的诊断标准， ${}^2$${}^2$^(2){ }^{2} 并且 $37\mathrm{\%}$$37\mathrm{\%}$37%37 \% 报告妊娠期间症状加重。 ${}^3$${}^3$^(3){ }^{3} 产前母体抑郁症会带来代际风险，包括早产和发育迟缓，并增加后代对精神病理学的易感性。 ${}^{4-10}$${}^{4-10}$^(4-10){ }^{4-10} 美国妇产科医师 ${}^{11}$${}^{11}$^(11){ }^{11} 学会围产期抑郁症工作组强调了对抑郁症进行早期筛查和怀孕期间干预的必要性。尽管如此，大多数已发表的工作和当前的医疗保健政策都强调预防产后抑郁症，而很少关注减少产前抑郁症。 ${}^{12}$${}^{12}$^(12){ }^{12} 由于怀孕是孕妇和发育中的胎儿都非常脆弱的敏感期，我们确定明确需要仅在怀孕期间实施随机临床试验 （RCT），目的是评估一种简短、安全的干预措施来减少产前抑郁症。

The US Preventive Services Task Force (USPSTF) showed that current interventions exhibit significant but small effects to prevent perinatal depression (defined broadly including pregnancy through 12 months post partum). ${}^{12}$${}^{12}$^(12){ }^{12} This recent USPSTF systematic review summarized perinatal counseling interventions and noted several limitations of the literature. They advocated for larger-scale effectiveness trials that use good-quality design, assess depression repeatedly throughout pregnancy with dimensional symptom measures, and focus on individuals at elevated risk for depression recruited from general primary obstetrics and gynecology (OB/GYN) care.
美国预防服务工作组 （USPSTF） 表明，目前的干预措施对预防围产期抑郁症（广义上包括妊娠至产后 12 个月）表现出显著但微小的效果。 ${}^{12}$${}^{12}$^(12){ }^{12} 最近的 USPSTF 系统评价总结了围产期咨询干预，并指出了文献的几个局限性。他们倡导更大规模的有效性试验，这些试验使用高质量的设计，使用维度症状测量在整个怀孕期间反复评估抑郁症，并关注从一般初级妇产科 （OB/GYN） 护理中招募的抑郁症风险较高的个体。

The present study follows the USPSTF’s recommendations for investigating psychosocial interventions ${}^{12}$${}^{12}$^(12){ }^{12} with few to no adverse effects on fetal development. The efficacy of interpersonal psychotherapy (IPT) has been evaluated previously with pregnant ${}^{13-16}$${}^{13-16}$^(13-16){ }^{13-16} and postpartum ${}^{17-19}$${}^{17-19}$^(17-19){ }^{17-19} participants, and these existing trials support the need for well-powered studies assessing the effect of IPT on depression within the prenatal period. There is a critical need to reduce depression within the prenatal period because both depression diagnosis and dimensional symptom elevations are risks for important health outcomes, including obstetric complications, preterm birth, decreased likelihood of breastfeeding, and child developmental delays. ${}^{20-23}$${}^{20-23}$^(20-23){ }^{20-23} Thus, reducing depression prenatally can benefit maternal health (eg, risk for postpartum depression) and improve offspring outcomes given links between prenatal depression and childhood developmental outcomes (eg, brain development, stress regulation, and psychopathology ${}^{5,6,24-27}$${}^{5,6,24-27}$^(5,6,24-27){ }^{5,6,24-27} ). We report data from this RCT (the Care Project) in which we compared an evidence-based brief IPT (MOMCare ${}^{28-30}$${}^{28-30}$^(28-30){ }^{28-30} ) with enhanced usual care (EUC).
本研究遵循 USPSTF 的建议，调查对胎儿发育 ${}^{12}$${}^{12}$^(12){ }^{12} 几乎没有不利影响的社会心理干预。人际心理治疗 （IPT） 的疗效先前已在怀孕 ${}^{13-16}$${}^{13-16}$^(13-16){ }^{13-16} 和产后 ${}^{17-19}$${}^{17-19}$^(17-19){ }^{17-19} 参与者中进行了评估，这些现有试验支持需要有力的研究来评估 IPT 对产前抑郁症的影响。迫切需要减少产前抑郁症，因为抑郁症诊断和维度症状升高都是重要健康结果的风险，包括产科并发症、早产、母乳喂养可能性降低和儿童发育迟缓。 ${}^{20-23}$${}^{20-23}$^(20-23){ }^{20-23} 因此，鉴于产前抑郁症与儿童发育结局（如大脑发育、压力调节和精神病理学 ${}^{5,6,24-27}$${}^{5,6,24-27}$^(5,6,24-27){ }^{5,6,24-27} ）之间的联系，减少产前抑郁症有益于孕产妇健康（如产后抑郁症的风险）并改善后代结局。我们报告了这项 RCT （护理项目） 的数据，其中我们将循证简报 IPT （MOMCare ${}^{28-30}$${}^{28-30}$^(28-30){ }^{28-30} ） 与增强常规护理 （EUC） 进行了比较。

We randomized 234 pregnant individuals recruited primarily from obstetrics clinics at 2 major medical centers in the Denver, Colorado, metropolitan area. Recruitment began July
我们随机分配了 234 名孕妇，这些孕妇主要从科罗拉多州丹佛市区 2 个主要医疗中心的产科诊所招募。招募于 7 月开始

Question Can depression be reduced during pregnancy and before birth using a brief, safe intervention?
问题 怀孕期间和出生前可以通过简短、安全的干预措施来减轻抑郁症吗？

Findings In this randomized clinical trial of 234 adult pregnant individuals, elevated symptoms were reported during routine obstetric care depression screening. Compared with enhanced usual care, brief interpersonal psychotherapy significantly improved depression symptoms and major depressive disorder diagnosis rate during pregnancy.
结果在这项对 234 名成年孕妇进行的随机临床试验中，在常规产科护理抑郁症筛查期间报告了症状升高。与强化常规护理相比，简短的人际心理治疗显著改善了妊娠期抑郁症状和重度抑郁障碍诊断率。

Meaning Brief interpersonal psychotherapy may be warranted to relieve depression in pregnant individuals with potential intergenerational benefits.
意义 可能需要进行简短的人际心理治疗来缓解怀孕个体的抑郁症，并具有潜在的代际益处。

2017 and ended August 2021 with a pause from mid-April through mid-June 2020 due to the COVID-19 pandemic. Initial screening was performed based on medical record review. Eligibility criteria included 18 to 45 years of age, English speaking, 25 weeks’ gestational age (GA) or less, singleton pregnancy, and endorsing elevated depression symptoms when screened as part of standard of care (Edinburgh Postnatal Depression Scale [EPDS] score $\ge 10$$\ge 10$>= 10\geq 10 ). Exclusion criteria included current illicit drug or methadone use and major health conditions requiring invasive treatments (eg, dialysis, blood transfusions, chemotherapy). Additional assessment for eligibility was performed at baseline to exclude (1) current or past psychosis or mania and (2) currently receiving cognitive behavioral therapy or IPT. The trial protocol is available in Supplement 1. Institutional review boards for the Protection of Human Subjects at the University of Denver and the University of Colorado Anschutz Medical Campus approved the study. Recruitment, outcomes, and adverse events were monitored by a data and safety monitoring board. Participants provided written and informed consent.
2017 年，到 2021 年 8 月结束，由于 COVID-19 大流行，从 2020 年 4 月中旬到 6 月中旬暂停。根据病历审查进行初步筛选。资格标准包括 18 至 45 岁、会说英语、胎龄 25 周 （GA） 或更短、单胎妊娠，以及在作为护理标准的一部分进行筛查时认可抑郁症状升高（爱丁堡产后抑郁量表 [EPDS] 评分 $\ge 10$$\ge 10$>= 10\geq 10 ）。排除标准包括当前使用非法药物或美沙酮以及需要侵入性治疗的主要健康状况（例如，透析、输血、化疗）。在基线时进行额外的资格评估，以排除 （1） 当前或过去的精神病或躁狂症和 （2） 目前正在接受认知行为疗法或 IPT。试验方案可在附录 1 中找到。丹佛大学和科罗拉多大学安舒茨医学校区的人类受试者保护机构审查委员会批准了这项研究。招募、结果和不良事件由数据和安全监测委员会监测。参与者提供了书面和知情同意书。

This study followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. Figure 1 provides the CONSORT diagram and illustrates allocation to intervention condition and participant flow (eMethods 1 in Supplement 2). Individuals were allocated to EUC or IPT. Participants (including 9 receiving no intervention) were considered part of the study once randomized (intent-to-treat design).
本研究遵循报告试验综合标准（Consolidated Standards of Reporting Trials， CONSORT）报告指南。图 1 提供了 CONSORT 图，并说明了干预条件和参与者流程的分配（附录 2 中的 eMethods 1）。个体被分配到 EUC 或 IPT。参与者 （包括 9 名未接受干预） 一旦随机化（意向治疗设计），则被视为研究的一部分。

Participants completed a baseline evaluation, including interview and questionnaire assessments. Eligible individuals were then randomly assigned to IPT or EUC using a computergenerated random numbers sequence. Participants were randomized in blocks of 2 and stratified on current MDD (assessed via the Structured Clinical Interview for DSM-5 [SCID5]) based on DSM-5 criteria, GA (above or below 15 weeks), and Medicaid status for each study arm. Participants were compensated for completing study measures (via REDcap or with blinded evaluator) 3 to 5 times prenatally: (1) baseline: mean (SD) of 16.7 (4.2) gestational weeks (prior to intervention), (2) 22.3 (4.1) weeks, (3) 25.7 (4.1) weeks, (4) 29.7 (4.2) weeks (near end of active IPT), and (5) 35.8 (1.5) weeks (end of gestation).
参与者完成了基线评估，包括访谈和问卷评估。然后使用计算机生成的随机数序列将符合条件的个体随机分配到 IPT 或 EUC。参与者被随机分为 2 个一组，并根据每个研究组的 DSM-5 标准、GA（高于或低于 15 周）和医疗补助状态，根据当前的 MDD（通过 DSM-5 结构化临床访谈 [SCID5] 评估）进行分层。参与者在产前完成研究措施（通过 REDcap 或盲法评估器）3 至 5 次获得补偿：（1） 基线：平均 （SD） 为 16.7 （4.2） 孕周（干预前），（2） 22.3 （4.1） 周，（3） 25.7 （4.1） 周，（4） 29.7 （4.2） 周（接近活动 IPT 结束）和 （5） 35.8 （1.5） 周（妊娠结束）。

An overview of the study timeline is shown in the eFigure in Supplement 2.
研究时间表的概述显示在附录 2 的 eFigure 中。

MomCare is a culturally relevant, collaborative care intervention that provides brief IPT. ${}^{30}$${}^{30}$^(30){ }^{30} Before starting IPT sessions, study therapists implemented a manualized ethnographic session ${}^{30}$${}^{30}$^(30){ }^{30} to engage pregnant individuals, sustain treatment participation, and help resolve practical, cultural, and psychological barriers to care. Brief IPT consists of eight 50-minute individual sessions, approximately a week apart, with the active phase of treatment during pregnancy; thereafter, maintenance care is allowed with less frequent sessions. ${}^{31}$${}^{31}$^(31){ }^{31} Intervention focuses on psychoeducation and interpersonal skill building to decrease interpersonal conflict and increase interpersonal support and competence. Individuals are educated about the link between feelings and interpersonal interactions and learn strategies to resolve interpersonal conflicts contributing to depression symptoms (eAppendix in Supplement 2). MOMCare includes key elements of collaborative care. Participants were provided community support resources and could be prescribed antidepressant medications.
MomCare 是一项与文化相关的协作式护理干预措施，提供简短的 IPT。 ${}^{30}$${}^{30}$^(30){ }^{30} 在开始 IPT 会议之前，研究治疗师实施了一次手动人种学会议 ${}^{30}$${}^{30}$^(30){ }^{30} ，以吸引怀孕者，维持治疗参与，并帮助解决护理的实际、文化和心理障碍。Brief IPT 包括 8 次 50 分钟的单独治疗，大约间隔一周，怀孕期间是积极的治疗阶段;此后，允许进行维护保养，但治疗频率较低。 ${}^{31}$${}^{31}$^(31){ }^{31} 干预侧重于心理教育和人际交往技能培养，以减少人际冲突并增加人际支持和能力。个人接受有关情感与人际互动之间联系的教育，并学习解决导致抑郁症状的人际冲突的策略（附录 2 中的附录）。MOMCare 包括协作护理的关键要素。参与者获得了社区支持资源，并可以开具抗抑郁药物。

All IPT therapists and collaborative care team members completed a 3-day training and were certified by Nancy Grote, PhD, a leading brief IPT expert for antenatal depression. IPT therapists were doctoral-level clinicians who followed detailed treatment manuals and received supervised training. Adherence checklists ensured that MOMCare was delivered with fidelity. Fidelity ratings were very high (mean, 1.90; scale ranged from 0 [needs work] to 2 [done well]) across sessions independently rated by MOMCare developers Nancy Grote, PhD, and Mary C. Curran, MSW. All participants had at least 1 session reviewed; $25\mathrm{\%}$$25\mathrm{\%}$25%25 \% to $40\mathrm{\%}$$40\mathrm{\%}$40%40 \% of sessions across active IPT were reviewed (eMethods 2 in Supplement 2). Most participants attended nearly all 8 prenatal IPT sessions (mean [SD], 7.27 [3.5]).
所有 IPT 治疗师和协作护理团队成员都完成了为期 3 天的培训，并获得了产前抑郁症领先的简短 IPT 专家 Nancy Grote 博士的认证。IPT 治疗师是博士级临床医生，他们遵循详细的治疗手册并接受监督培训。遵守清单确保 MOMCare 保真交付。在 MOMCare 开发人员 Nancy Grote 博士和 Mary C. Curran（MSW）独立评分的会话中，保真度评分非常高（平均值为 1.90;范围从 0 [需要工作] 到 2 [做得好]）。所有参与者都至少审查了 1 次会议; $25\mathrm{\%}$$25\mathrm{\%}$25%25 \% $40\mathrm{\%}$$40\mathrm{\%}$40%40 \% 对活跃 IPT 的会话进行了综述（附录 2 中的 eMethods 2）。大多数参与者几乎参加了所有 8 次产前 IPT 会议 （平均值 [SD]，7.27 [3.5]）。

EUC augmented the usual standard of care pregnant individuals received within OB/GYN clinics through their obstetric clinicians and/or social workers. EUC consisted of maternity support services, which provides mental health counseling integrated within the obstetric setting and 1-on-1 consultation session with doctoral-level clinicians. Through maternity social services, pregnant individuals were offered mental health support, based on patient preferences, including prepartum depression care (eclectic counseling [not IPT or cognitive behavioral therapy] or psychiatric consultation including medication) and other community services. During this 1-on-1 sixty-minute consultation session, the clinician reviewed written psychoeducational materials on perinatal depression so participants could better recognize mood symptoms during pregnancy and discussed with the participant ways to talk with partners or other supports about depression to elicit help. Clinicians conducted ongoing monitoring with participants and provided referrals to patients to overcome barriers and when care was needed. Extensive community resources were provided, including information on additional alternative community mental
EUC 提高了孕妇通过产科临床医生和/或社会工作者在 OB/GYN 诊所接受的通常护理标准。EUC 包括产科支持服务，提供产科环境中的心理健康咨询以及与博士级临床医生的一对一咨询。通过产科社会服务，根据患者的偏好为孕妇提供心理健康支持，包括产前抑郁症护理（折衷咨询 [不是 IPT 或认知行为疗法] 或包括药物治疗在内的精神病学咨询）和其他社区服务。在这个 1 对 60 分钟的咨询过程中，临床医生审查了有关围产期抑郁症的书面心理教育材料，以便参与者能够更好地识别怀孕期间的情绪症状，并与参与者讨论如何与伴侣或其他支持人员谈论抑郁症以寻求帮助。临床医生对参与者进行了持续监测，并在需要护理时向患者提供转诊，以克服障碍。提供了广泛的社区资源，包括有关其他替代社区心理的信息

Participants allocated to interpersonal psychotherapy and designated as “did not receive intervention” did not attend any prenatal intervention sessions.
被分配到人际心理治疗组并被指定为 “未接受干预” 的参与者没有参加任何产前干预会议。
health and counseling services, essential items and housing programs, and local resource centers for pregnancy and postpartum support. Overall, 58 participants (48.8%) reported using additional counseling. EUC occurred during the same time frame as MOMCare.
健康和咨询服务、必需品和住房计划，以及当地怀孕和产后支持资源中心。总体而言，58 名参与者 （48.8%） 报告使用了额外的咨询。EUC 发生在与 MOMCare 相同的时间范围内。

The 20-item Symptom Checklist (SCL-20) measures depression symptoms from the full Symptom Checklist-90-R. ${}^{32}$${}^{32}$^(32){ }^{32} Items are rated on a scale of 0 to 4 and summed to generate a total score, ranging from 0 to 80 . Higher ratings indicate more depression. Scores below 20 suggest MDD remission. ${}^{33}$${}^{33}$^(33){ }^{33} Prior work indicates reliability and validity, including with pregnant participants. ${}^{34}$${}^{34}$^(34){ }^{34} Internal consistency was excellent ( $a=.91$$a=.91$a=.91a=.91 at all 3 time points: baseline, 28 gestational weeks, and 35 gestational weeks).
包含 20 个项目的症状清单 （SCL-20） 从完整的症状清单-90-R 中测量抑郁症状。 ${}^{32}$${}^{32}$^(32){ }^{32} 项目按 0 到 4 的等级进行评级，并求和以生成总分，范围从 0 到 80 。评分越高表示抑郁程度越高。分数低于 20 表明 MDD 缓解。 ${}^{33}$${}^{33}$^(33){ }^{33} 先前的工作表明可靠性和有效性，包括怀孕的参与者。 ${}^{34}$${}^{34}$^(34){ }^{34} 内部一致性非常好 （ $a=.91$$a=.91$a=.91a=.91 在所有 3 个时间点：基线、 28 孕周和 35 孕周）。

EPDS is used to screen maternal depression across the peripartum period. Research shows reliability and validity in pregnancy. ${}^{35,36}$${}^{35,36}$^(35,36){ }^{35,36} Participants provided ratings on a scale of 0 to 3. Higher scores signify greater depression. Total scores range from 0 to 30 . Scores of 10 or higher suggest probable depression. ${}^{36}$${}^{36}$^(36){ }^{36} Internal consistencies ranged from $a=0.82$$a=0.82$a=0.82a=0.82 to 0.89 across 5 time points.
EPDS 用于筛查整个围产期的产妇抑郁症。研究表明怀孕的可靠性和有效性。 ${}^{35,36}$${}^{35,36}$^(35,36){ }^{35,36} 参与者提供了 0 到 3 的评分。分数越高表示抑郁越严重。总分范围从 0 到 30 。10 分或更高提示可能患有抑郁症。 ${}^{36}$${}^{36}$^(36){ }^{36} 5 个时间点的内部一致性范围为 $a=0.82$$a=0.82$a=0.82a=0.82 0.89。

Prior to randomization, trained independent evaluators administered the SCID-5 at baseline to determine participants’ diagnostic status using DSM-5 criteria, including MDD and the exclusion criteria of mania or psychosis (current or lifetime). Additionally, independent evaluators interviewed participants post partum to ascertain MDD status at the end of pregnancy including the 2 weeks prior to delivery. Interviewers were highly reliable: $\kappa \ge 0.95$$\kappa \ge 0.95$kappa >= 0.95\kappa \geq 0.95 for MDD based on reliability review of $50\mathrm{\%}$$50\mathrm{\%}$50%50 \% of SCIDs randomly selected.
在随机分组之前，训练有素的独立评估者在基线时施用 SCID-5，以使用 DSM-5 标准确定参与者的诊断状态，包括 MDD 和躁狂症或精神病（当前或终生）的排除标准。此外，独立评估员在产后采访了参与者，以确定妊娠末期（包括分娩前 2 周）的 MDD 状态。访谈者高度可靠： $\kappa \ge 0.95$$\kappa \ge 0.95$kappa >= 0.95\kappa \geq 0.95 对于基于随机选择的 SCID 的 $50\mathrm{\%}$$50\mathrm{\%}$50%50 \% 可靠性审查的 MDD。