In-home counseling and peer support keep postnatal depression in check
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In-home counseling by health visitors trained to identify depression in new mothers reduces the prevalence of postnatal depression at 12 months, according to a trial in the UK, while a Canadian study indicates that telephone-based peer support is also effective in preventing postnatal depression among women at risk.
Both studies are reported in the January 16 issue of BMJ Online First.
To determine the long-term effectiveness of an in-home psychological intervention for postnatal depression, Dr. C. Jane Morrell at the University of Huddersfield and colleagues conducted a prospective, cluster-randomized trial among 4084 women from 101 general practices near Trent, England.
“Health visitors are qualified nurses, with special experience in child health, health promotion and health education, employed as part of the NHS community health service,” Dr. Morrell told Reuters Health. “Part of a health visitor’s role is to visit families with new babies, in their home, as part of routine child health surveillance.”
In her group’s study, she added, health visitors were trained to provide “an appropriate, derivative approach, delivering critical elements from cognitive behavioural therapy or person-centred therapy.”
A total of 2749 women were allocated to the intervention and 1335 to usual care. Based on an Edinburgh postnatal depression scale (EPDS) score of 12 or higher at 6 weeks, 404 subjects in the intervention group and 191 in the control group had postnatal depression.
Among 418 women with elevated scores who were re-assessed at 6 months, 34% of those in the intervention group and 46% in the control group still had scores of 12 or higher (adjusted odds ratio 0.60, p = 0.028).
Dr. Morrell’s team detected an “unexpected non-specific effect of the training intervention on the cohort of all women as randomized,” such that 12.4% of the intervention group vs 16.7% of the control group had EPDS scores of 12 or higher at 6 months (p = 0.003). These benefits were maintained at the 12-month assessment.
This finding suggests that “as a result of their training, health visitors in the intervention group might have extended their enhanced relationship skills, such as warmth and empathy, thereby improving engagement with all women on their caseload.”
“The key to the effect of this psychological approach may lie in part in the benefit uniquely from the health visitors’ existing relationship with the woman, the enhanced antenatal input and ongoing supportive engagement with the women,” Dr. Morrell added.
She recommends that health visitors be trained to detect postnatal depression, and “to develop specialised skills to enable them to offer psychotherapeutic interventions.”
In a separate randomized study, Dr. Cindy-Lee Dennis at the University of Toronto and associates evaluated the benefits of telephone support provided by volunteers who had experienced and recovered from postnatal depression. The volunteers participated in a 4-hour training session prior to contacting study subjects.
Using a web-based screening survey and follow-up telephone call, public health nurses recruited 701 women at high risk based on an EPDS score > 9. Subjects were randomized to receive peer support group plus usual care, or usual care alone.
Contacts were made by peer volunteers within 3 days of randomization, with intervention group subjects receiving an average of 8.8 contacts by 12 weeks.
Women in the intervention group were less likely to have EPDS scores > 12 at the 12-week assessment than those in the control group (14% vs 25%, odds ratio 2.1, p
< 0.001).
According to mailed evaluations, more than 80% of women in the intervention group were satisfied with their experience and would recommend it to a friend in a similar situation.
The Canadian team suggests that telephone-based interventions may be more successful than traditional support groups because they are "not only flexible, private, and non-stigmatising, but they also reduce differences related to socioeconomic status and healthcare barriers" such as lack of transportation.
"Not enough people know about postnatal depression," Dr. Morrell noted. "Prospective parents need to know how to identify it, so that women do not to feel ashamed or worried about sharing difficult feelings with family and health professionals. Families also need to know exactly what treatment options are available for them."
By Karla Gale
BMJ 2009;338:a3045, a3064.
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