Background Validation for depression in preschool children has been established; however, to date no empirical investigations of interventions for the early onset disorder have been conducted. Based on this and the modest efficacy of available treatments for childhood depression, the need for novel early interventions has been emphasized. Large effect sizes for preschool psychotherapies for several Axis I disorders suggest that earlier intervention in depression may also be promising. Therefore, a novel form of treatment for preschool depression, Parent Child Interaction Therapy Emotion Development (PCIT-ED) was developed and tested. Methods A preliminary randomized controlled trial (RCT) was conducted comparing PCIT-ED to psycho-education in depressed 3-7 year olds and their caregivers. N=54 subjects met symptom criteria for DSM-IV MDD and were randomized, N=19 subjects completed the active treatment (N=8 drop-outs) and N=10 completed psycho-education (N=17 drop-outs). Results Both groups showed significant improvement in several domains, with PCIT-ED showing significance in a greater number of domains. An Intent-to-Treat analysis suggested that PCIT-ED was significantly more effective than psycho-education on executive functioning (p=0.011, ES=0.12) and emotion recognition skills (p=0.002, ES=0.83). Conclusions The RCT proved feasible and suggests an individual control condition should be used in future trials to minimize differential drop-out. These pilot data, although limited by power, suggest that PCIT-ED may be a promising early intervention for depression. Larger scale randomized controlled trials of PCIT-ED for depressed preschoolers are now warranted.

Background Psychotherapies with known efficacy in adolescent depression have been adapted for prepubertal children; however, none have been empirically validated for use with depressed very young children. Due to the centrality of the parent-child relationship to the emotional well being of the young child, with caregiver support shown to mediate the risk for depression severity, we created an Emotional Development (ED) module to address emotion development impairments identified in preschool onset depression. The new module was integrated with an established intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT). Preliminary findings of an open trial of this novel intervention, PCIT-ED, with depressed preschool children are reported. Methods PCIT was adapted for the treatment of preschool depression by incorporating a novel emotional development module focused on teaching the parent to facilitate the child’s emotional development and enhance emotion regulation. Eight parent-child dyads with depressed preschoolers participated in 14 sessions of treatment. Depression severity, internalizing and externalizing symptoms, functional impairment, and emotion recognition/discrimination were measured pre and post treatment. Results Depression severity scores significantly decreased with a large effect size (1.28). Internalizing and externalizing symptoms as well as functional impairment were also significantly decreased pre to post treatment. Conclusions PCIT-ED appears to be a promising treatment for preschoolers with depression and the large effect sizes observed in this open trial suggest early intervention may provide a window of opportunity for more effective treatment. A randomized controlled trial of PCIT-ED in preschool depression is currently underway.

during pregnancy have generally decreased. [3][4][5] These reports encourage more detailed characterization of patterns of substance use during the course of pregnancy.

Background Depression is common in low-income pregnant women, and treatments need to be fitted to meet their needs. We conducted a randomized controlled trial comparing brief interpersonal psychotherapy (brief-IPT) to enhanced treatment as usual (ETAU) for perinatal depression in low-income women. The brief-IPT model is designed to better engage low-income women by utilizing an engagement session, providing flexible delivery of sessions, and pragmatic case management. Methods Pregnant women, aged ≥ 18, between 12–30 weeks gestation were recruited from an urban prenatal clinic. Women scoring ≥ 10 on the Edinburgh Depression Scale and meeting depressive disorder criteria were randomized to either brief-IPT (n=21) or ETAU (n=21). We assessed treatment outcomes, acceptability, and feasibility of the intervention (measured by session attendance). Results Depression scores significantly decreased in both brief-IPT and ETAU. Brief-IPT participants reported significant improvements in social support satisfaction as compared to ETAU participants, even after controlling for concurrent depressive symptoms. Brief-IPT participants reported high satisfaction with the program. However, many participants did not participate in the full 9-session course of treatment (average sessions attended = 6, range 0–17). Limitations Small sample size, use of self-report measures, and lack of an active psychotherapy control group limits interpretation of study results. Conclusions Brief-IPT for perinatal depression is acceptable to low-income women and is helpful for improving depressive symptoms and social support. However, feasibility of the treatment was limited by relatively low session attendance in spite of efforts to maximize treatment engagement. Additional modifications to meet the needs of low-income women are discussed.

Objective Preterm children are at greater risk for psychiatric disorders than their term-born peers including anxiety disorders and ADHD. Prior research has focused primarily on children born at early gestational ages. Less is known about the rate of psychiatric disorders among late preterm or early term children. Additionally, whether a history of maternal depression, also associated with prematurity, impacts the risk for psychiatric disorders remains underexplored. Method Preschoolers between ages 3 and 6 years (N=306) were recruited for a study examining preschool depression that included healthy and disruptive preschoolers. Preschoolers were placed in the following groups: Late preterm (34–36 weeks, n=39), early term (37–39 weeks, n=78) and full term (40–41 weeks, n=154). DSM-IV psychiatric disorders were assessed via the Preschool Age Psychiatric Assessment. Maternal history of psychiatric disorders was assessed using the Family Interview for Genetic Studies. Results Late preterm children had higher rates of any Axis I psychiatric diagnosis (odds ratio [OR] 3.18, CI 1.09–4.76) and of any anxiety disorder (OR 3.74, CI 1.59–8.78) than full term children after adjusting for gender, ethnicity, family income, and IQ. There were no differences in rates of psychiatric diagnoses between early term and full term children. A history of maternal depression mediated the relationship between late preterm birth and anxiety disorders in preschoolers. Conclusions Late preterm children were at increased risk for anxiety disorders at preschool age. A history of maternal depression mediated this association. Findings confirm the extension of the risk of psychiatric disorders associated with prematurity to the late preterm group, and suggest that maternal depression may play a key role in this risk trajectory.