Improving Postpartum Mental Health and Healthy Lifestyle Behaviors in Women of Color Who Are Pregnant and Experiencing Depression, Anxiety, and Stress Through Group Prenatal Care: A Randomized Controlled Trial.

INTRODUCTION: A mental health epidemic exists in women of color who are pregnant, with alarming rates of depression and anxiety. Furthermore, the majority of these women do not receive treatment because of inadequate screening, mental health stigma, and lack of access to mental health care professionals. The purpose of this study was to evaluate the 6-week and 6-month postpartum effects of the Creating Opportunities for Personal Empowerment (COPE)-Pregnancy (COPE-P) program, administered by midwives, compared with a health promotion education program on mental health and healthy lifestyle behaviors and beliefs of Black and Hispanic women experiencing depression, anxiety, or stress.

METHODS: The study was a longitudinal, 2-group randomized controlled trial with 299 Black and Hispanic participants who screened high on depression, anxiety, or stress scales. In total, 41% of women screened met study eligibility criteria. Two 6-session group prenatal care interventions-the COPE-P cognitive-behavioral skills-building (CBSB) program and a health promotion with discussion attention control-were evaluated. Valid and reliable measures included the General Anxiety Disorder-7 scale, Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Healthy Lifestyle Beliefs Scale, and Healthy Lifestyle Behaviors Scale, which were assessed at baseline, postintervention, 6 weeks postpartum, and 6 months postpartum.

RESULTS: Two-way analyses of variance and longitudinal multilevel growth models assessed outcomes. Both groups demonstrated rapid, significant decreases in depression, anxiety, and stress (P <.001) over time through 6 months postpartum. Only the COPE-P group's significant improvement in healthy lifestyle behaviors was sustained through 6 weeks postpartum (P <.001). Participants who completed more CBSB activities showed greater improvements in outcomes than all other participants.

DISCUSSION: CBSB and health promotion content provided in group prenatal care by midwives decreased depression, anxiety, and stress that persisted through 6 months postpartum. CBSB programming sustained longer-term improvements in healthy lifestyle beliefs and behaviors. Performing more CBSB activities led to greater improvements in outcomes. The study was registered at the US National Institutes of Health (ClinicalTrials.gov) (NCT03416010).