Background. Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention. Methods. We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. ' Preparing for Parenthood ', a structured antenatal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview. Results. Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1n22 (95 % CI 0n63-2n39), P l 0n55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders. Conclusions. Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation.
In combination these findings may contribute to the future design of both effective and acceptable interventions to prevent postnatal depression. One such modified intervention is described and its impact on engagement outlined.
The antenatal psychosocial intervention to prevent postnatal depression, Preparing for Parenthood, was evaluated in an additional qualitative study of the participants' experience of the classes. This was to complement the findings of the core study with respect to the intervention's immediate impact on their emotional well‐being. All the women interviewed who attended the intervention considered it a positive experience. However, initial indications are that the intervention did not decrease, overall, the likelihood of a woman's developing postnatal depression. The distinction between developing a ‘pleasant’ and an ‘effective’ health promotion intervention requires careful negotiation and longer‐term assessment.
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