Postnatal Depression Headed Off by Nurses, Peers


Two forms of postnatal intervention—one with trained nurses or midwives, and another with a peer—significantly reduced the likelihood of postnatal depression, according to the findings of two studies.

The studies “add to the growing evidence that postnatal depression can be effectively treated and possibly prevented,” Dr. Cindy-Lee Dennis of the department of psychiatry at the University of Toronto and one of the lead investigators, wrote in an accompanying editorial.

The first study assessed the impact of an intervention conducted by “health visitors” trained to identify depressive symptoms using the Edinburgh postnatal depression scale (EPDS) and to use clinical mood assessment skills, wrote Dr. C. Jane Morrell of the University of Huddersfield (England) and her colleagues.

The health visitors provided weekly 1-hour counseling sessions in the mother's home for up to 8 weeks. A control group was given usual care, without the in-home sessions.

A total of 4,084 eligible women consented to participate, and 595 had a 6-week EPDS score greater than or equal to 12, which indicates the possibility of depression. The maximum score is 30. Ultimately, 418 women had follow-up EPDS scores at 6 months and were analyzed.

At 6 months, the 271 women in the intervention group whose 6-week score had been greater than or equal to 12 were 40% less likely to have a score greater than or equal to 12, compared with the 147 women in the control group. The differences in the mean EPDS scores were sustained at 12 months (BMJ 2009;338:a3045[doi:10.1136/bmj.a3045]). The study was funded entirely by the NHS.

The second randomized, controlled trial looked at the impact of a telephone-based intervention with nonmedical professional peers for postnatal women with an EPDS greater than 12.

A total of 315 women received usual care with follow-up information available at 12 weeks. In contrast, the 297 women who were randomized to the intervention group and had follow-up data at 12 weeks received usual care plus telephone access to a peer volunteer—a mother who had personally experienced postnatal depression.

“Women in the intervention group were significantly less likely to have symptoms of depression at the 12-week assessment than [were] those in the control group (odds ratio 2.1),” wrote the authors, led by Dr. Dennis. “Specifically, 14% (40/297) of women in the intervention group had a score greater than 12, compared with 25% (78/315) in the control group” (BMJ 2009;338:a3045[doi:10.1136/bmj.a3064]).

The study was supported by the Canadian Institutes of Health.

Authors from both studies reported having no conflicts of interests.

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