A Comparison of Profiles of Transtheoretical Model Constructs of Change among Depressed and Nondepressed Women at Risk for an Alcohol-Exposed Pregnancy.

INTRODUCTION: The efficacy of a series of interventions to reduce risk of alcohol-exposed pregnancies is well-established, yet some subsets of women remain at risk. For instance, in CHOICES, a randomized clinical trial of an intervention to prevent alcohol-exposed pregnancy, nondepressed women reduced risk drinking at roughly twice the rate of women with depression (49% vs. 24%). This secondary analysis of CHOICES data examines constructs that can explicate differences between nondepressed and depressed women in the process of changing alcohol behavior.

METHODS: Profile analysis was used to compare the current status on transtheoretical model constructs of change between groups of depressed (n = 41) and nondepressed (n = 171) women in CHOICES at baseline and at the 9-month follow-up (end of the study). Participants were women aged 18 to 44 years who were at risk for an alcohol-exposed pregnancy at baseline. Measures included the Timeline Followback, Brief Symptom Inventory, and the transtheoretical model measures of decisional balance, self-efficacy, and experiential and behavioral processes of change.

RESULTS: Differences in profiles of the transtheoretical model constructs between groups were found at baseline and 9 months (p < .001). Women with depression had a profile that has historically predicted failure to change. Profiles among depressed women were distinguished by high scores on cons for changing alcohol use and temptation to drink.

CONCLUSIONS: Prevention interventions should assess for depression and target interventions to improve success. Results of this study can help practitioners to better tailor interventions to the needs of individuals with depression by strategically targeting decisional balance and self-efficacy.