Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 1. Impact on maternal mood

Cooper, P. J. M.; Murray, Lynne A.; WILSON, A.; Romaniuk, Helena

doi:10.1192/bjp.02.177

Cited by 84 publications

(191 citation statements)

References 19 publications

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“…Among their patients with elevated EPDS scores (≥10), women in the enhanced care group evidenced a greater improvement compared with those in the standard care municipality. This result is consistent with earlier studies of non-directive counselling, also referred to as ‘Listening Visits’ 2–6. The data underscore the effectiveness of depression treatment by PHNs.…”

Section: Commentarysupporting

confidence: 91%

Incorporating mental healthcare into routine postpartum nursing is a promising approach for reducing depression in new mothers

Segre

2011

Evid Based Nurs

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Section: Commentarysupporting

confidence: 91%

Incorporating mental healthcare into routine postpartum nursing is a promising approach for reducing depression in new mothers

Segre

2011

Evid Based Nurs

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“…The trial has good internal and external validity and, with more than twice as many participants as the previous largest study, 36 provides more evidence than before of the benefit of psychologically informed approaches for women with postnatal depression. 16 We followed postnatal women to 18 months, whereas the final outcome in most previous studies of postnatal depression was measured at one to three months postnatally, 12 and also incorporated an economic evaluation.…”

Section: Strengths Of the Studymentioning

confidence: 95%

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

Morrell

Slade

Warner

et al. 2009

BMJ

186

204

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Objective To evaluate benefits for postnatal women of two psychologically informed interventions by health visitors. Design Prospective cluster trial randomised by general practice, with 18 month follow-up. Setting 101 general practices in Trent, England. Participants 2749 women allocated to intervention, 1335 to control. Intervention Health visitors (n=89 63 clusters) were trained to identify depressive symptoms at six to eight weeks postnatally using the Edinburgh postnatal depression scale (EPDS) and clinical assessment and also trained in providing psychologically informed sessions based on cognitive behavioural or person centred principles for an hour a week for eight weeks. Health visitors in the control group (n=49 38 clusters) provided usual care. Main outcome measures Score ≥12 on the Edinburgh postnatal depression scale at six months. Secondary outcomes were mean Edinburgh postnatal depression scale, clinical outcomes in routine evaluation-outcome measure (CORE-OM), state-trait anxiety inventory (STAI), SF-12, and parenting stress index short form (PSI-SF) scores at six, 12, 18 months. Results 4084 eligible women consented and 595 women had a six week EPDS score ≥12. Of these, 418 had EPDS scores available at six weeks and six months. At six months, 34% women (93/271) in the intervention group and 46% (67/147) in the control group had an EPDS score ≥12. The odds ratio for score ≥12 at six months was 0.62 (95% confidence interval 0.40 to 0.97, P=0.036) for women in the intervention group compared with women in the control group. After adjustment for covariates, the odds ratio was 0.60 (0.38 to 0.95, P=0.028). At six months, 12.4% (234/1880) of all women in the intervention group and 16.7% (166/995) of all women in the control group had scores ≥12 (0.67, 0.51 to 0.87, P=0.003). Benefit for women in the intervention group with a six week EPDS score ≥12 and for all women was maintained at 12 months postnatally. There was no differential benefit for either psychological approach over the other. Conclusion Training health visitors to assess women, identify symptoms of postnatal depression, and deliver psychologically informed sessions was clinically effective at six and 12 months postnatally compared with usual care. Trial registration ISRCTN92195776. INTRODUCTIONPostnatal depression is a global problem and an important public health issue. About 13% of women experience depression during the first postnatal year, 1 yet there are problems in recognition because its clinical assessment is complex. There can be serious consequences for the mother, her child, 2 and family and a risk of suicide (the leading cause of maternal death in England and Wales) and infanticide in some severely depressed mothers.3 Fathers are also more likely to be depressed if their partner is depressed, 4 and the children of fathers who experience depression in the postnatal period are at increased risk of behaviour problems. 5In primary care, psychological interventions are as clinically effective in the management of depression...

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“…To circumvent these barriers, psychotherapy has been delivered to mothers in their home. Most of the trials have been conducted during the immediate postpartum period, with varying results depending whether an evidence-based treatment was provided, fidelity was maintained, and mothers were retained long enough to receive a minimum dose (Appleby, Warner, Whitton, & Faragher, 1997; Cooper, Murray, Wilson, & Romaniuk, 2003; Spinelli & Endicott, 2003; van Doesum, Riksen-Walraven, Hosman, & Hoefnagels, 2008). Prior to the current study, interpersonal psychotherapy (IPT), an effective treatment for depressive symptoms and MDE, had been tested in middle-income antepartum and postpartum mothers (Grote et al, 2009; Weissman, Markowitz, & Klerman, 2007) but had not been adapted for in-home delivery to low-income mothers.…”

mentioning

confidence: 99%

Parenting Enhancement, Interpersonal Psychotherapy to Reduce Depression in Low-Income Mothers of Infants and Toddlers

et al. 2013

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Background Depressive symptoms and clinical depression are highly prevalent in low-income mothers and negatively affect their infants and toddlers. Objectives To test interpersonal psychotherapy combined with parenting enhancement on depressive symptoms and parenting behavior, compared with usual care. Method Mothers (n = 226) of Early Head Start infants and toddlers from the southeastern and northeastern United States were randomized to the intervention delivered in-home by psychiatric mental health advanced practice nurses or usual care delivered by generalist nurses. Rigorous clinical depressive symptom and depression assessments and videotaped, coded mother-child interactions were used as baseline and 14-, 22-, and 26-week postintervention measures. Results Both the intervention and control groups had significantly reduced Hamilton Rating Scale for Depression scores at each subsequent time point compared to baseline (p < .0001). However, only mothers receiving the intervention showed a significant increase in positive involvement with their child, as measured by closeness, positive affect, affection, and warm touch at T4 (t = 2.22, df = 156, p < .03). Discussion Both intervention and control conditions resulted in symptom reduction, but only the intervention mothers showed significant interaction changes with their child, an essential step in reducing the negative child outcomes associated with maternal depressive symptoms. Results suggest that a combination of generalist and specialist nurses could be used to treat depressive symptoms in these mothers. Further study with longer postintervention observation is needed to see if, over time, the intervention led to longer-lasting symptom reduction.

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Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 1. Impact on maternal mood

Abstract: Psychological intervention for post-partum depression improves maternal mood (EPDS) in the short term. However, this benefit is not superior to spontaneous remission in the long term.

Cited by 84 publications

References 19 publications

Incorporating mental healthcare into routine postpartum nursing is a promising approach for reducing depression in new mothers

Incorporating mental healthcare into routine postpartum nursing is a promising approach for reducing depression in new mothers

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

Parenting Enhancement, Interpersonal Psychotherapy to Reduce Depression in Low-Income Mothers of Infants and Toddlers

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