Two Non-Doctor Approaches Help Ease Postnatal Depression


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 recent research.

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 (BMJ 2009:338:a3045 [doi:10.1136/bmj.a3064]).

The first study assessed the impact of a postnatal intervention conducted by trained “health visitors.” In the United Kingdom, health visitors are registered nurses or midwives who postnatally work with mothers on feeding, safety, physical and emotional development, and other aspects of health and child care, according to the National Health Service Web site.

The health visitors were “trained to identify depressive symptoms using the Edinburgh postnatal depression scale (EPDS) and to use clinical assessment skills to assess a mother's mood, including suicidal thoughts,” wrote Dr. C. Jane Morrell of the University of Huddersfield (England) and her colleagues (BMJ 2009;338:a3045 [doi:10.1136/bmj.a3045]).

The health visitors provided weekly 1-hour counseling sessions in the mother's home for up to 8 weeks, starting at 8 weeks postnatally. A control group was given usual care, without the in-home psychological 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 who participated in the program had follow-up EPDS scores at 6 months and were analyzed.

At 6 months, the authors reported that 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.

Furthermore, wrote Dr. Morrell and her associates, “the differences in the mean EPDS scores at 6 months … were sustained at 12 months.”

The trial “provides new evidence of the effectiveness of a package of training for health visitors to identify symptoms of depression postnatally and to provide psychologically informed sessions,” wrote the authors. They declared no competing interests and wrote that 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. Usual care “could have included, if available, the mother proactively seeking the services from public health nurses, physicians, other providers, and various community resources.”

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.

The volunteers were trained in providing telephone-based support and made referrals to health care professionals, if necessary, and in role playing.

A minimum of four contacts between the mother and peer volunteer were made.

“Women in the intervention group were significantly less likely to have symptoms of postnatal 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.”

More than 80% of the 221 women who received peer counseling and evaluated their experience said that they would recommend the support to a friend and that they were satisfied with the experience.

Dr. Dennis disclosed having no individual competing interests.

Her study was supported by the Canadian Institutes of Health.

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