���Ҵ�ý�ƽ������

Faculty member strives to increase clinical impact of new research and to address under-served population: women of childbearing age who are depressed

Women have twice the odds of suffering depression as men, and the chances rise during childbearing years. While the World Health Organization has found that depression is the second-leading cause of disability in women of childbearing age worldwide, Sona Dimidjian notes the dearth of studies on depression among many of these women.

“It’s amazing to recognize the lack of research that’s been done on depression, particularly on pregnant or postpartum women,” Dimidjian, observed recently. The number of peer-reviewed studies on depressed pregnant women could be counted on one hand. “It’s egregious,” she said, adding:

“We as a field haven’t really stepped up to study this issue rigorously.”

Dimidjian, an assistant professor of psychology and neuroscience at the University of Colorado, is facing that challenge. At the same time, she’s tackling a related problem: that the most current knowledge gleaned from scientific research often fails to get applied in the world of clinical psychotherapy.

With respect to childbearing women, Dimidjian drives the issue home in terms of its impact in Colorado. ���Ҵ�ý�ƽ������ 70,000 babies are born each year in Colorado, and about 12 percent of these mothers (or 8,400 women) experience a depressive episode.

“The vast majority of these women receive no treatment or inadequate treatment,” Dimidjian said in a speech earlier this year.

As Dimidjian notes, some illuminating research on the efficacy of treatment for depression is being done. When she was a graduate student at the University of Washington, she completed a randomized trial comparing the efficacy of different forms of psychotherapy with antidepressants.

Dimidjian’s research team found that a behavioral treatment worked as well as antidepressants for more severely depressed patients. The work was published in 2006 in the Journal of Consulting and Clinical Psychology, the top journal in her area of clinical psychology.

“This was an important but, I would suggest, limited scientific advance,” Dimidjian said of the study. “The limitation is that the penetration of such findings into actual clinical care has been minor, at best.”

Dimidjian was also part of a major study published earlier this year that highlighted limitations of antidepressants for depressed adults.

This work was published in the Journal of the American Medical Association and made headlines nationwide. It was the cover story on Newsweek. If the past is prologue, however, the findings’ effect on clinical treatment may be limited.

To help bridge the gap between cutting-edge research and effective treatment, Dimidjian founded CU’s Clinical Research, Education and Treatment (or CREST) program, within the department of psychology and neuroscience. The program, launched in January, focuses on developing, investigating and providing evidence-based treatments to reduce human suffering and to promote sustained well-being.

The program’s research examines the clinical benefit of psychological interventions such as cognitive and behavior therapies, and contemplative practices, such as mindfulness meditation and yoga for women during pregnancy, postpartum and beyond.

The CREST program has a three-fold mission: to develop and study rigorously new interventions for depression, to train students and community clinicians in evidence-based treatments, and to provide the highest quality clinical care to women in the community. The clinical care is provided through the CREST Women’s Mental Health and Wellness Clinic, co-directed by Dimidjian and her colleague Tina Pittman-Wagers.

CREST research programs target preventing depression, treating depression and training clinicians.

In the realm of preventing depression, the CREST program is developing an eight-week class that teaches meditation, yoga, information about depression and strategies to prevent depression.

Funded by the National Institute of Mental Health, the study is being conducted jointly by Dimidjian and her collaborators, Sherryl Goodman at Emory University, and Arne Beck at Kaiser Permanente in Colorado.

In the treatment of depression, the CREST program is conducting multiple studies, focusing on the use of behavioral therapy to treat depression among women generally and among pregnant and postpartum women in particular.

The training mission of CREST focuses on undergraduate and graduate students at CU and practicing clinicians in the community.

Given Dimidjian’s previous research showing that behavioral therapy is an effective way to treat depression, Dimidjian and her collaborators are developing innovative ways to make this treatment available broadly. One study focuses on developing and testing an online training program to teach behavioral activation to mental-health clinicians. The study is funded by the National Institute of Mental Health.

Samuel Hubley, one of Dimidjian’s current graduate students, also will examine for his dissertation study the benefit of this online-training program for mental-health clinicians and students in the Colorado area specifically.

Additionally, CREST has trained 250-300 clinicians in the Colorado area to work more effectively with pregnant and postpartum women.

“This work does have the potential to impact the future,” Dimidjian said. “The training and education we provide aims to support new generations of clinical scientists and practitioners who are committed to integrating science and practice.”

Those who have worked with Dimidjian—and are among the next generation of clinicians—agree.

“Being involved with Dr. Dimidjian’s research and the CREST program was the highlight of my career at the University of Colorado,” said Liz Eustis, who graduated from CU with a major in psychology in May 2010 and who worked as the undergraduate outreach coordinator at CREST on a grant funded by the Outreach Committee.

Noting the gap between research and clinical practice, Eustis said her time with CREST showed her that it is possible to transport evidence-based therapy from the lab to the clinic.

“I am truly inspired by her synthesis of research and clinical care,” Eustis said. “When I see people suffering, I believe there is hope because of people like Dr. Dimidjian.”

Eustis is now working as a research assistant in Massachusetts General Hospital. She plans to attend graduate school in clinical psychology and said her work with Dimidjian laid the foundation for her future work in graduate school and beyond.

“Time and time again I’m inspired by her commitment to clinical research and compassionate care.”

Mikaela Kinnear, doctoral student in clinical psychology and clinic and intake coordinator for CREST’s Women’s Mental Health & Wellness Clinic, concurs. Kinnear screens potential clients and provides administrative support for the clinic.

“As a graduate-student training clinic, we are committed to training students in evidence-based practices,” she said. Additionally, she sees clients as a graduate-student therapist.

Kinnear said she has learned much about the infrastructure of a clinic that combines research and practice. She has gained experience with utilizing empirically validated diagnostic measures and treatments, monitoring treatment outcomes, and organizing trainings for disseminating evidence-based treatments to clinicians in the broader community.

“Putting this philosophy into practice will be valuable in my future work as a treatment researcher and clinician,” she added.

The Women’s Mental Health and Wellness Clinic offers individual therapy, couple and family therapy, and skill-building group therapy services. The clinic primarily uses cognitive and behavioral therapies and the clinical application of mindfulness meditation and other contemplative practices. All clinical services are informed by the latest scientific research. Staff therapists supervised by licensed clinical psychologists provide clinical services on a sliding-fee scale. The clinic hopes to expand these services in the future by including pharmacotherapy provided by a board-certified psychiatrist who has expertise in women’s mental health. If you are interested in supporting the mission of the Women’s Mental Health and Wellness Clinic, please call 303-492-7378 (303-49-CREST).