Trajectories of long-term outcomes for postnatally depressed mothers treated with group interpersonal psychotherapy

Abstract

There is evidence that psychological treatments for postnatal depression are effective in the short-term; however, whether the effects are enduring over time remains an important empirical question. The aim of this study was to investigate the depressive symptoms and interpersonal functioning of participants in a randomised controlled trial (RCT) of group interpersonal psychotherapy (IPT-G) at 2 years posttreatment. The study also examined long-term trajectories, such as whether participants maintained their recovery status, achieved later recovery, recurrence or persistent symptoms. Approximately 2 years posttreatment, all women in the original RCT (N = 50) were invited to participate in a mailed follow-up. A repeated measures analysis of variance assessed differences between the treatment and control conditions on depression and interpersonal scores across five measurement occasions: baseline, mid-treatment, end of treatment and 3-month and 2-year follow-up. Chi-square tests were used to analyse the percentage of participants in the four recovery categories. Mothers who received IPT-G improved more rapidly in the short-term and were less likely to develop persistent depressive symptoms in the long-term. Fifty seven percent of IPT-G mothers maintained their recovery over the follow-up period. Overall, IPT-G participants were significantly less likely to require follow-up treatment. Limitations include the use of self-report questionnaires to classify recovery. The positive finding that fewer women in the group condition experienced a persistent course of depression highlights its possible enduring effects after treatment discontinuation. Further research is needed to improve our long-term management of postnatal depression for individuals who are vulnerable to a recurrent or chronic trajectory.

The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review

“…Followup assessments at 3 months posttreatment revealed that there was no significant group difference related to the mother–child relationship at follow‐up, however there were positive trends favoring the experimental group (Mulcahy et al., ). At 2 years posttreatment, no significant group differences were found related to the mother–child relationship (Reay et al., ). When MAI effect sizes were meta‐analyzed (Mulcahy et al., ; Reay et al., ) using fixed effects analysis for standardized mean differences, the overall effect favoured the intervention, however, the 95% confidence interval for the difference crossed zero (SMD = 0.36, –0.05–0.77, p = 0.085).…”

“…At 2 years posttreatment, no significant group differences were found related to the mother–child relationship (Reay et al., ). When MAI effect sizes were meta‐analyzed (Mulcahy et al., ; Reay et al., ) using fixed effects analysis for standardized mean differences, the overall effect favoured the intervention, however, the 95% confidence interval for the difference crossed zero (SMD = 0.36, –0.05–0.77, p = 0.085).…”

“…Although there were some positive findings, group differences were not identified in either study. Addressing PPD, Four trials (plus two follow‐ups) evaluated the effect of IPT on parenting and child development (Cicchetti, Rogosch, & Toth, ; Clark et al., ; Mulcahy, Reay, Wilkinson, & Owen, ; O'Hara, Stuart, Gorman, & Wenzel, ; Reay et al., ; Toth, Rogosch, Manly, & Cicchetti, ). In one trial, the efficacy of toddler–parent psychotherapy as a preventive intervention for fostering secure attachment relationships and cognitive development in the offspring of depressed mothers was evaluated (Cicchetti et al., ).…”

Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress

“…Recent evidence from a randomised controlled trial showed that group IPT for postnatal depression reduced depressive symptomatology and improved interpersonal functioning as indicated by more positive reports of relationships with partner and social supports and more positive perceptions of the mother-infant relationship (Mulcahy et al 2010). Further, these researchers subsequently reported that, at 2 years post-treatment, the women receiving IPT were less likely to report persistent depressive symptoms (Reay et al 2012), but longer-term outcomes regarding the parent-child relationship were not reported. There is, as yet, limited evidence that IPT delivered in pregnancy can be effective in preventing postnatal depression; however, some promising results (Zlotnick et al 2006) require further research.…”

Combined therapy with interpersonal psychotherapy adapted for borderline personality disorder: A two-years follow-up

“…Favourable data supporting the long-term efficacy of IPT derived from follow-up studies of IPT or therapy combining IPT and pharmacotherapy that were performed in other mental disorders, such as major depression of adolescents (Young et al, ,2010Jacobsen et al, 2012;Zhou et al, 2015) and adults (Schramm et al, 2008;Zobel et al, 2011;Toth et al, 2013;Lemmens et al, 2015), perinatal depression (Brandon et al, 2012;Reay et al, 2012), dysthymia (Browne et al, 2002), and eating disorders (Wilfley et al, 2002;Carter et al, 2011;Hilbert et al, 2012).…”