Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study

Abstract

BackgroundUniversal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorised, not gender-informed and overlooked relevant risk factors. This study aimed to determine whether an innovative brief psycho-educational program for mothers, fathers and first newborns, which addressed salient learning needs about infant behaviour management and adjustment tasks in the intimate partner relationship, prevented postpartum mental health problems in primiparous women.MethodsA before and after controlled study was conducted in primary care in seven local government areas in Victoria, Australia. English-speaking couples with one-week old infants were invited consecutively to participate by the maternal and child health nurse at the universal first home visit. Two groups were recruited and followed sequentially: both completed telephone interviews at four weeks and six months postpartum and received standard health care. Intervention group participants were also invited to attend a half-day program with up to five couples and one month old infants, facilitated by trained, supervised nurses. The main outcome was any Composite International Diagnostic Interview (CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors associated with the outcome were established by logistic regression controlling for potential confounders and analysis was by intention to treat.ResultsIn total 399/646 (62%) women were recruited; 210 received only standard care and 189 were also offered the intervention; 364 (91%) were retained at follow up six months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%) were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107 (15%) in the intervention group. In those without a psychiatric history, the adjusted odds ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in the intervention group compared to the control group.ConclusionsA universal, brief psycho-educational group program for English-speaking first time parents and babies in primary care reduces de novo postpartum mental disorders in women. A universal approach supplemented by an additional program may improve effectiveness for women with a psychiatric history.Trial registrationACTRN 12605000567628.

Health behaviour change interventions for couples: A systematic review

“…Two targeted healthy adults who were not at risk of a specific chronic illness (Niederhauser, Maddock, LeDoux, & Arnold, 2005; Wallace, Raglin, & Jastremski, 1995), two had no control group (Homan, Litt, & Norman, 2012; Shoham, Rohrbaugh, Trost, & Muramoto, 2006), two targeted the at‐risk individuals through their female partners (Chan, Leung, Wong, & Lam, 2008; Matsuo et al ., 2010), partner inclusion was not compulsory in three (de Vries, Bakker, Mullen, & van Breukelen, 2006; Prestwich et al ., 2005; Wakefield & Jones, 1998), and three did not target physical health issues (Fisher, Wynter, & Rowe, 2010; Midmer, Wilson, & Cummings, 1995; Sciacca, Dube, Phipps, & Ratliff, 1995). …”

Modifiable partner factors associated with perinatal depression and anxiety: A systematic review and meta-analysis

“…Targeting the couple relationship repositions perinatal mental health as a family issue, rather than something that is specific to mothers (Fisher et al, 2010;McKellar et al, 2006;Paulson and Bazemore, 2010). A number of researchers have called for increased attention on fathers' emotional health (e.g., DeSouza, 2014).…”

“…Improved understanding of how partner support is related to both depression and anxiety will enable future prevention efforts to use a trans-diagnostic approach. A trans-diagnostic approach is likely to be more efficacious and cost-effective than focusing solely on depression (Fisher et al, 2010).…”

Integrative Approach to Child and Adolescent Mental Health

“…Already a number of successful programs have been developed, such as nurse visitation in the perinatal period [48]. Recent emerging evidence shows that current interventions aiming to prevent postnatal depression in women are beneicial and efective not only for women with depression but also for those sufering from anxiety and high stress disorders [49][50][51].…”