Improving help-seeking for postnatal depression and anxiety: a cluster randomised controlled trial of motivational interviewing

Abstract

Low uptake of treatment by women with symptoms of postnatal depression and anxiety is consistently reported. This study examined whether a brief motivational interviewing (MI) intervention delivered by Maternal and Child Health Nurses (MCHNs) during routine emotional health assessments improves help-seeking following childbirth. In this parallel two-group cluster randomised controlled trial, MCHNs delivered a MI intervention ('PRIMER', n = 20) or Routine Care (n = 20) at women's (n = 541) postnatal consultations. The primary outcome was help-seeking over the 12 months post-birth. Other outcomes were emotional distress measured by the Edinburgh Postnatal Depression Scale, Beck Depression Inventory-Revised and Depression Anxiety Stress Scales, and barriers to help-seeking obtained by self-report via a checklist of potential barriers that was presented to women to select from if applicable. 27.4% of the sample experienced emotional distress over the 12 months post-birth. When comparing women who experienced emotional distress with those who did not, odds of seeking help were 4.0 times higher for the MI condition than Routine Care (p = .004). Of the women who sought help from a psychologist, 47.6% in the MI condition attended 6 + sessions versus 20.0% in Routine Care (numbers too small for reliable significance test). There was a non-significant trend of lower depression, anxiety and stress in the MI condition. Three risk factors for postnatal depression predicted help-seeking: antenatal anxiety (OR = 2.8, p = .002), depression history (OR = 2.5, p = .002) and self-esteem (OR = 0.7, p = .04). Common barriers to seeking help were thinking that one would or should be able to manage without help (endorsed by 11.1%). Treatment uptake for postnatal distress can be increased with MI. Training MCHNs in MI was feasible and valued. Given the devastating effects of depression, further research is needed to ascertain whether MI can improve mental health outcomes. Australian New Zealand Clinical Trials Registry (ACTRN12611000635965), 22 June 2011.

Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa

“…There is also a possibility that symptoms were played down/ underreported due to the stigma associated with mental health disorders in many African cultures [45, 46]. Women may worry that their child caring capacity may be called into question and they may also be reluctant to take up treatment interventions involving prescription drugs while breastfeeding [10, 17, 47]. On average 50% of depressed women often go undiagnosed, with only 20% of those diagnosed seek treatment [11–13, 47].…”

Development and validation of a three‐item version of the Edinburgh Postnatal Depression Scale

“…Compared to currently available screening methods, after a brief assessment to detect mothers at risk for postpartum depression, clinicians would have more time available to explore symptoms, provide psychoeducation, and boost patients' treatment motivation, actions that may help to reduce the treatment gap for postpartum depression. For instance, recently Holt et al (2017) have demonstrated that a brief motivational interviewing intervention during well‐child check‐ups can increase treatment uptake for postnatal depression and anxiety.…”

“…In practice, busy primary care clinicians (i.e., a nurse or a physician) who have half an hour to conduct a thorough, comprehensive evaluation of the child's growth and provide guidance to parents and/or caregivers, are also in charge of the administration of the screening for postpartum depression (Chilean Ministry of Health, 2014). In this context, although administering the EPDS is feasible in 5 min, this instrument might be long enough to represent a missed chance for providing tailored information about test results, briefly educate mothers about postpartum depression, and motivating access to treatment for depressed mothers (Holt, Milgrom, & Gemmill, 2017).…”

Postpartale psychische Störungen und ihre Bedeutung für die Wochenbettbetreuung

“…Aufgrund der zum Teil lang andauernden psychischen Störungen sollten Mütter frühzeitig über die Möglichkeit informiert werden, eine Familienhebamme zu beantragen, um eine zusätzliche Betreuung im ersten Lebensjahr des Kindes zu gewährleisten. [45].…”