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Efficacy of a Program for the Management of Depression in Pregnant Women in Primary Care in São Paulo, Brazil

NCT ID: NCT01719289

Last Updated: 2012-11-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-03-31

Study Completion Date

2014-09-30

Brief Summary

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Background: depression during pregnancy is an important problem for public health. It has direct consequences for the affected woman, her children and family, and is a strong predictor of post-partum depression. In developing countries depression during pregnancy is highly common, and usually unrecognized and untreated.

Aim: to evaluate the effectiveness and cost-effectiveness of an intervention delivered by nurse assistants in the management of pregnant women with depression in primary care clinics that adopt the Family Health Strategy in Sao Paulo, Brazil.

Method: PROGRAVIDA is a cluster randomized controlled trial with pregnant women with depression attending pre-natal care in 12 Primary Care Units with Family Health Program, covering an area of 400,000 inhabitants in Sao Paulo, Brazil. The intervention follows a stepped-care approach and is delivered by health professionals working at the primary care unit responsible by the care of the women. All women from the intervention group receive a program based on psycho-education and problem solving techniques, delivered by a nurse assistant at the women's homes. The program comprises 8 sessions, 6 during pregnancy and 2 after delivery. Intensity of depressive symptoms is assessed using the PHQ-9, at the beginning of the sessions. Women with severe depression are referred to the family doctor and are assessed for the need of antidepressant medication. The control group receives routine care. The primary outcome is remission of depressive symptoms 4-months after the inclusion in the study. Secondary outcomes include remission of depressive symptoms at 6 months after delivery. Women are also assessed for socioeconomic and household characteristics, social support and obstetric complications. The effectiveness and cost-effectiveness of the intervention will be assessed with intention-to-treat analysis, using the clinical outcome and the assessment of quality of life (EQ-5D) four months after inclusion in the trial.

Detailed Description

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Despite the high prevalence of depressive disorders in pregnancy and puerperium and the possible negative consequences of these frames for women, children and family, there are still very scarce evidence on the effectiveness of interventions of low cost and viable, that can be made available on the net of Primary Health Care in Brazil and other middle or low income countries.

The main objective of this study is to evaluate the effectiveness of a depression management program, simple and low cost, delivered by nurse assistants, in reducing symptoms of depression in pregnant women treated in primary care clinics that adopt the Family Health Strategy (FHS) in São Paulo, compared to routine care. We will also assess the cost-effectiveness of this intervention.

We are conducting a community cluster randomized trial with pregnant women with symptoms of depression, attending antenatal care in primary care clinics that adopt the FHS in São Paulo. Participating clinics (12) were randomly allocated to have their nurse assistants receiving training and supervision to perform a program for management of depression among pregnant women (experimental group) or to offer routine care (control group).

Conditions

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Depression

Keywords

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depression problem solving

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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PROGRAVIDA

All women in this arm receive a stepped-care program for depression based on psycho-education and problem solving techniques.

Group Type EXPERIMENTAL

PROGRAVIDA

Intervention Type BEHAVIORAL

Women in the intervention group receive a program based on psycho-education and problem solving techniques, delivered by a nurse assistant at the women's homes. The program comprises 8 sessions, 6 during pregnancy and 2 after delivery. Intensity of depressive symptoms is assessed using the PHQ-9, at the beginning of the sessions. Women with severe depression are referred to the family doctor and are assessed for the need of antidepressant medication.

Treatment as usual

Primary health care professionals in charge of prenatal care are notified by the research team about all women with depression receiving pre-natal care and included in the trial. Primary health care professionals decide how to treat these women without any interference from the research team.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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PROGRAVIDA

Women in the intervention group receive a program based on psycho-education and problem solving techniques, delivered by a nurse assistant at the women's homes. The program comprises 8 sessions, 6 during pregnancy and 2 after delivery. Intensity of depressive symptoms is assessed using the PHQ-9, at the beginning of the sessions. Women with severe depression are referred to the family doctor and are assessed for the need of antidepressant medication.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

Pregnant women attending antenatal care in selected primary care clinics with Family Health Programs, who score a PHQ-9\>=5 just after the first antenatal consultation or around the 20th week of pregnancy.

Exclusion Criteria

Moderate to high suicidal risk (assessed with a standardised protocol),

* Ongoing psychiatric treatment,
* Not able to understand Portuguese.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Conselho Nacional de Desenvolvimento Científico e Tecnológico

OTHER_GOV

Sponsor Role collaborator

University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Paulo R Menezes, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Sao Paulo

Marcia Scazufca, PhD

Role: STUDY_DIRECTOR

University of Sao Paulo

Locations

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Faculdade de Medicina da Universidade de Sao Paulo

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Faculdade de Medicina da Universidade de Sao Paulo

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Paulo R Menezes, PhD

Role: CONTACT

Phone: +55 11 30617093

Email: [email protected]

Facility Contacts

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Paulo R Menezes, PhD

Role: primary

Paulo R Menezes, PhD

Role: primary

Other Identifiers

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CNPq 575320/2008-7

Identifier Type: -

Identifier Source: org_study_id