Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial

Abstract

HV training was effective compared with HV usual care in reducing the proportion of at-risk women with a 6-month EPDS score > or = 12, with a wide confidence interval for the estimated intervention effect, suggesting that the true treatment effect may be small. The effect remained for 1 year. The economic evaluation demonstrated that the HV intervention was highly likely to be cost-effective compared with the control. There was no difference in outcomes between the CBA and the PCA groups.

Cognitive behavioral therapy in combination with systemic family therapy improves mild to moderate postpartum depression

“…Of note, the reduction seen 24 months after delivery was lower than that seen at 18 months, and sleep latency increased markedly. This suggests that: 1) depression in the psychotherapy group improved from the end of intervention to 24 months after delivery when compared with that in the control group; the quality of sleep in the psychotherapy group was superior to that in the control group (i.e., psychological intervention could improve the symptoms of depression within 19 months, which is consistent with previous reports 29,30 ); 2) from 42 days to 18 months after delivery, depression in the control group was also attenuated; this may be attributed to the selfhealing tendency of postpartum depression 31 and to the gradual regularity of the child's life and the gradual stability of the child's health; and 3) 24 months after delivery, depression deteriorated slightly and quality of sleep was reduced to a certain extent; this might be related to the fact that children are entering the first rebellious phase or ''terrible twos'' at this stage, leading to an increase in behavioral problems and in difficulties during parenting.…”

Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

“…There has been a pledge of £40 million of support to fund additional training for health visitors (Conservative Research Department, 2010). We provide here details of training which was found to be both clinically effective and cost effective (Morrell et al, 2009b). This training module might now be commissioned with sustained encouragement from Trust managers adequately influencing educational programmes and contract setting with universities (Cowley, 2009).…”

“…This trial was the largest trial of postnatal depression and the largest trial of a health visitor intervention ever conducted. The trial has generated evidence of the pragmatic cost-effectiveness of a package of training for health visitors to 12 months postnatally (Morrell et al, 2009b).…”

Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses

“…It is reported that women are often reluctant to pursue health care for PND for a variety of reasons. These include a lack knowledge about the condition meaning they are not aware they have it, thinking they could or were expected to cope with it without help, stigma and a fear of failure a fear of losing their baby if they admit to having PND, the fear of giving the family a bad name, and the fear of being labelled as mentally ill. 13,36 Cultural reasons have also been reported, these include the fact that the family may discourage women from obtaining help as it is seen as unacceptable to discuss such issues with people external to the family. Furthermore, it is reported that health professionals may limit the number of women who come forward for treatment for PND by making inappropriate assessments and having insufficient knowledge of PND to provide adequate care.…”

“…Based on a sample of 3449 postnatal women, 595 had an EPDS 13 score of 12 or more at 6 weeks postpartum; an estimated proportion of 17.3% [95% confidence interval (CI) 16.0 to 18.5]. However, it should be noted that the EPDS does not yet have a proven role in the identification, screening or diagnosis of PND.…”