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Postnatal depression can be effectively treated and possibly prevented

January 16, 2009

Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care, BMJ Online

Health visitors can be trained to identify women with postnatal depression and offer effective treatment, while telephone peer support (mother to mother) may halve the risk of developing postnatal depression, suggests research published on bmj.com today.

About 13% of women experience postnatal depression in the year following the birth of their child. But postnatal depression is frequently undetected and untreated, often because of poor recognition of symptoms, unawareness of treatment options or fear of stigmatisation.

Antidepressants have been shown to be an effective treatment for postnatal depression, but many women are reluctant to take drugs, especially when breast feeding. Psychological therapies may provide an alternative treatment, but their effectiveness is unclear.

In one of the largest trials of postnatal depression, Dr Jane Morrell and colleagues analysed whether psychological interventions were effective in treating the symptoms of postnatal depression. Over 4,000 mothers from 101 general practices in England consented to take part. Practices were randomised so women received either a cognitive behavioural approach or a person centred approach from specially trained health visitors or health visitor usual care.

Health visitors in the intervention group were trained to identify depressive symptoms and deliver cognitive behavioural or person centred sessions for an hour per week for up to eight weeks. Validated scales were used to assess depressive symptoms among the mothers. A threshold score of 12 or more identified women with symptoms of depression. Participants were followed up for 18 months and assessed every six months using a postal questionnaire.

At both six months and 12 months postnatally, the mothers who received care from the specially trained health visitors showed significantly greater reductions in depressive symptoms than those who received health visitor usual care. Mothers in the intervention group with depressive symptoms at six weeks were 40% less likely to have depressive symptoms at six months than those receiving health visitor usual care.

The researchers found no benefit of one psychological approach over the other.

In a second study, Dr Cindy-Lee Dennis and colleagues from Canada examined the effectiveness of telephone based peer support to prevent postnatal depression in high risk women.

After web-based screening of more than 21,000 women from seven health regions in Ontario, Canada, 701 were identified at high risk of postnatal depression and randomised to receive standard postnatal care or standard care and the support of a peer volunteer (who had experienced postnatal depression themselves).

Mothers who received peer support had half the risk of developing postnatal depression at 12 weeks after birth than those in the control group. Mothers were receptive to receiving telephone-based peer support and over 80% said they were satisfied with their experience and would recommend this support to a friend.

Women and family members need to be educated about postnatal depression so they can recognise the symptoms, and treatment needs to be convenient and accessible to new mothers, says Dr Cindy-Lee Dennis in an accompanying editorial.

She calls for a coordinated multidisciplinary approach to identify postnatal depression involving all health professionals who come into contact with new mothers including midwives, doctors, nurses and health visitors.

BMJ-British Medical Journal

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