Relational Group Intervention for Postpartum Depression in Substance-Using Women:A Needs Assessment and Curriculum Plan

Background: Patients with comorbid substance use disorder and postpartum depression (PPD) have the highest rates of severe depression. Death to overdose and suicide in postpartum patients remains the primary cause of perinatal death in the state of Utah. The lack of available psychotherapy for postpartum substance-dependent women exposes a gap in treatment for vulnerable patients. Methods: A needs assessment for group psychotherapy, conducted by chart review with statistical analysis of PPD using the Edinburg Postpartum Depression Scale (EPDS) for depression assessment in postpartum substance-dependent patients was completed. To address the comorbidity of substance use and PPD a Cognitive Behavioral Therapy (CBT) facilitator's manual and tool kit were adapted to guide a 12-week postpartum intervention. An executive treatment plan for staff and patients and a dissemination plan for stakeholders were developed for group psychotherapy postpartum women with substance dependency. Results: Post data collection, this needs assessment study found that mothers with substance dependency scored severe depression (EPDS > 19) at 16.9% (n = 71) compared to all delivering mothers, whose severe depression (EPDS >19) scored at 3.8% (n =1188). An execution plan for implementing group CBT was ready for implementation as early as fall 2020. Conclusions: Assessing the need for postpartum psychotherapyin women with substance dependency to reduce severe depression and rates of suicide is a national and state healthcare priority. Data reveal a four-fold increase in severe depression rates of substance using patients when compared to all postpartum patients. Correlation of PPD with risk of suicide compels further clinical research and pilot studies of group interventions in postpartum substance use specialty clinics.