Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up

Abstract

Substantial evidence links antenatal depression, anxiety and stress with negative effects on foetal development, resulting in enduring problems in child development. Despite this, there is a paucity of research on intervention programmes designed to address depression and anxiety, and none that include infant outcomes. We aimed to evaluate the efficacy of a brief treatment for maternal depression and anxiety in pregnancy in a sample of women with a diagnosed depressive disorder. We developed a cognitive behavioural therapy treatment for antenatal depression and anxiety and evaluated it in a feasibility trial. This was followed by a pilot randomised controlled trial (RCT) which collected data on the efficacy of the brief intervention and follow-up data on infants. The feasibility study (n = 25) yielded promising results for adherence, acceptability and improvements in depression and anxiety (Beck Depression Inventory and Beck Anxiety Inventory). The RCT (n = 54) again showed excellent adherence and acceptability and supported the efficacy of the treatment. Strong reductions in anxiety were observed during pregnancy, and improvements in depression were maintained at 9 months representing a moderately large effect size. Nine-month infant outcomes showed several medium to large effects favouring the intervention in domains including problem solving, self-regulation and stress reactivity, which were independent of maternal postnatal mood. Treating severe depression and anxiety during pregnancy with a brief cognitive behavioural therapy (CBT) intervention appears feasible and worthwhile. To reliably detect clinically meaningful effects on infant outcomes, larger RCTs are likely to be required.

Systematic review and meta‐analysis of non‐pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women

“…(): PSA and PSS Milgrom et al. (): EPDS and a Structured Clinical Interview for DSM‐IV (SCID). From an initial sample of 169 women referred to the study with an EPDS score of 12 or more, 54 (32%) women were finally eligible and consented to participate in a SCID.…”

“…Four studies evaluated psychological interventions including: CBT (Bittner et al., ; Milgrom et al., ); CBA (Brugha et al., ) and MCBT (Faramarzi et al., ).…”

“…Some authors described the theoretical basis for CBT interventions (Bittner et al., ; Milgrom et al., ), psychological support/CBA interventions (Brugha et al., ; Côté‐Arsenault et al., ) and mind‐body interventions such as acupressure (Bastani, ), mindfulness (Guardino et al., ; Vieten & Astin, ; Woolhouse et al., ), guided imagery (Jallo et al., ), yoga (Newham et al., ; Satyapriya et al., ) and relaxation (Bastani et al., , Chang et al., ; Teixeira et al., ; Tragea et al., ; Urech et al., ; Ventura et al., ).…”

Brief Interpersonal Psychotherapy for depression during pregnancy in a low-income population: A randomized controlled trial

“…Early studies reported significant difficulties enrolling and retaining pregnant or postpartum women in Cognitive Behavioral Therapy (CBT) (Carter et al, 2005; McKee et al, 2006). As a result, recent studies have modified CBT to improve feasibility and acceptability among pregnant women (McGregor et al, 2014; Milgrom et al, 2015; O’Mahen et al, 2013). For example, O’Mahen and colleagues (2013) utilized an engagement interview followed by modular sessions delivered in a flexible format (home or clinic) with an “active outreach strategy” to retain participants.…”

“…For example, O’Mahen and colleagues (2013) utilized an engagement interview followed by modular sessions delivered in a flexible format (home or clinic) with an “active outreach strategy” to retain participants. Milgrom and colleagues (2015) modified their CBT based intervention for pregnancy by changing from 12 group sessions to 8 individual sessions. Both studies showed promise in increasing engagement and retention into psychotherapy and in effectively reducing depressive symptoms.…”