Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care

Abstract

Objective To evaluate benefits for postnatal women of two psychologically informed interventions by health visitors. Design Prospective cluster trial randomised by general practice, with 18 month follow-up. Setting 101 general practices in Trent, England. Participants 2749 women allocated to intervention, 1335 to control. Intervention Health visitors (n=89 63 clusters) were trained to identify depressive symptoms at six to eight weeks postnatally using the Edinburgh postnatal depression scale (EPDS) and clinical assessment and also trained in providing psychologically informed sessions based on cognitive behavioural or person centred principles for an hour a week for eight weeks. Health visitors in the control group (n=49 38 clusters) provided usual care. Main outcome measures Score ≥12 on the Edinburgh postnatal depression scale at six months. Secondary outcomes were mean Edinburgh postnatal depression scale, clinical outcomes in routine evaluation-outcome measure (CORE-OM), state-trait anxiety inventory (STAI), SF-12, and parenting stress index short form (PSI-SF) scores at six, 12, 18 months. Results 4084 eligible women consented and 595 women had a six week EPDS score ≥12. Of these, 418 had EPDS scores available at six weeks and six months. At six months, 34% women (93/271) in the intervention group and 46% (67/147) in the control group had an EPDS score ≥12. The odds ratio for score ≥12 at six months was 0.62 (95% confidence interval 0.40 to 0.97, P=0.036) for women in the intervention group compared with women in the control group. After adjustment for covariates, the odds ratio was 0.60 (0.38 to 0.95, P=0.028). At six months, 12.4% (234/1880) of all women in the intervention group and 16.7% (166/995) of all women in the control group had scores ≥12 (0.67, 0.51 to 0.87, P=0.003). Benefit for women in the intervention group with a six week EPDS score ≥12 and for all women was maintained at 12 months postnatally. There was no differential benefit for either psychological approach over the other. Conclusion Training health visitors to assess women, identify symptoms of postnatal depression, and deliver psychologically informed sessions was clinically effective at six and 12 months postnatally compared with usual care. Trial registration ISRCTN92195776. INTRODUCTIONPostnatal depression is a global problem and an important public health issue. About 13% of women experience depression during the first postnatal year, 1 yet there are problems in recognition because its clinical assessment is complex. There can be serious consequences for the mother, her child, 2 and family and a risk of suicide (the leading cause of maternal death in England and Wales) and infanticide in some severely depressed mothers.3 Fathers are also more likely to be depressed if their partner is depressed, 4 and the children of fathers who experience depression in the postnatal period are at increased risk of behaviour problems. 5In primary care, psychological interventions are as clinically effective in the management of depression...

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.…”

Not identifying with postnatal depression: a qualitative study of women’s postnatal symptoms of distress and need for support

“…In line with previous research, our findings highlight the need for ongoing relationships with caregivers and different models of postnatal care. [32] For example, the involvement of psychologically aware health visitors who could provide simple psychological interventions as required has been shown to be beneficial [32].Women in this sample wanted both the opportunity to talk about their distress in-depth with a non-judgemental empathic person who could reassure them, and peer support from other women with children [33,34].…”

Gir bedre fødsels=omsorg

“…I tillegg til å berike den ansatte viser også undersøkelser at denne typen oppfølgingsprogram har god effekt for den kvinnen det gjelder (17,18). Dette gir en forebyggende effekt på ulike former for utvikling-og atferdsmessige vansker hos små barn, selv om det fortsatt er begrenset kunnskap om varigheten av de positive effektene ved ulike intervensjonstiltak.…”