Protocol for a feasibility randomised trial of low-intensity interventions for antenatal depression: ADAGIO trial comparing interpersonal counselling with cognitive behavioural therapy

Abstract

IntroductionOne in eight women suffer from depression during pregnancy. Currently, low-intensity brief treatment based on cognitive behavioural therapy (CBT) is the only talking treatment widely available in the National Health Service (NHS) for mild and moderate depression. CBT involves identifying and changing unhelpful negative thoughts and behaviours to improve mood. Mothers in our patient advisory groups requested greater treatment choice. Interpersonal counselling (IPC) is a low-intensity version of interpersonal therapy. It may have important advantages during pregnancy over CBT because it targets relationship problems, changes in role and previous losses (eg, miscarriage). We aim to compare CBT and IPC for pregnant women with depression in a feasibility study.Methods and analysisA two-arm non-blinded randomised feasibility study of 60 women will be conducted in two UK localities. Women with depression will be identified through midwife clinics and ultrasound scanning appointments and randomised to receive six sessions of IPC or CBT. In every other way, these women will receive usual care. Women thought to have severe depression will be referred for more intensive treatment. After 12 weeks, we will measure women’s mood, well-being, relationship satisfaction and use of healthcare. Women, their partners and staff providing treatments will be interviewed to understand whether IPC is an acceptable approach and whether changes should be introduced before applying to run a larger trial.Several groups of patients with depression during pregnancy have contributed to our study design. A patient advisory group will meet and advise us during the study.Ethics and disseminationStudy results will inform the design of a larger multicentre randomised controlled trial (RCT). Our findings will be shared through public engagement events, papers and reports to organisations within the NHS. National Research Ethics Service Committee approved the study protocol.Trial registration numberISRCTN11513120.

Maternal postnatal depression and offspring emotional and behavioural development at age 7 years in a UK-birth cohort: the role of paternal involvement

“…Recognising and addressing paternal PND during the postnatal period will not only support fathers but also improve their ability to support their partners and children. The findings of this study also highlight the importance of involving fathers in the treatment of maternal depression through partner-assisted therapies, such as interpersonal counselling, 87,88 as well as interventions that address the importance of paternal engagement and caregiving directly via education and, for instance, video-feedback.…”

Maternal postnatal depressive symptoms and offspring emotional and behavioral development at age 7 years in a U.K. birth cohort: The role of paternal involvement.

“…Recognising and addressing paternal PND will support fathers and improve their ability to support their partners and children. The findings also highlight the importance of involving fathers in the treatment of maternal depression through partner-assisted therapies (e.g., interpersonal counselling; Brandon et al, 2012 ; Ingram et al, 2019 ), as well as interventions that address the importance of paternal involvement and caregiving directly via education and video-feedback ( Lawrence et al, 2013 ; Olhaberry et al, 2019 ). Father-child conflict played a role in transmitting the negative effects of maternal PND on offspring development, even after accounting for higher levels of paternal PND.…”

‘Asking for help’: a qualitative interview study exploring the experiences of interpersonal counselling (IPC) compared to low-intensity cognitive behavioural therapy (CBT) for women with depression during pregnancy

“…A randomised feasibility trial (ADAGIO) comparing the acceptability of offering IPC for antenatal depression in routine NHS primary care services in England compared to low-intensity CBT has recently been completed [ 16 , 17 ]. The ADAGIO trial was successful in recruiting pregnant women with mild-moderate depression.…”