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Pragmatic randomized trial of antenatal intervention to prevent postnatal depression by reducing psychosocial risk factors

By Traolach S. Brugha, S. Wheatley, Nick A. Taub, A. Culverwell, T. Friedman, P.H. Kirwan, David R. Jones and D.A. Shapiro


Background. Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge\ud of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention.\ud \ud Methods. We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. ` Preparing for Parenthood', a structured antenatal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview.\ud \ud Results. Assignment to the intervention group did not significantly impact on post- natal depression (odds ratio for GHQ-Depression 1.22 (95% CI 0.63-2.39), P = 0.55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders.\ud \ud Conclusions. Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation

Publisher: Cambridge University Press
Year: 2000
OAI identifier:

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  1. (1990). Antenetal intervention to prevent post-natal depression 1281
  2. (1994). Can non-psychotic depression be prevented?
  3. (1999). Caregiver support for postpartum depression. doi
  4. (1993). Course of depression in patients with hypertension, myocardial infarction, or insulin-dependent diabetes. doi
  5. (1995). Depression undertreatment : lost cohorts, lost opportunities? doi
  6. (1987). Detection of postnatal depression. Development of the 10 item Edinburgh Postnatal Depression Scale. doi
  7. (1995). Evaluation of antenatal and postnatal support to overcome postnatal depression: a randomized, controlled trial. doi
  8. (1986). Fetal health locus of control scale : development and validation. doi
  9. (1997). Global mortality, disability, and the contribution of risk factors : Global Burden of Disease Study. doi
  10. (1999). Just because I like it doesn’t mean it has to work: personal experience of an antenatal psychosocial intervention designed to prevent postnatal depression. doi
  11. (1983). Life event scales for obstetric groups. doi
  12. (1980). Life events and social support in puerperal depression. doi
  13. (1993). Mental disorder and the strategies of prevention. doi
  14. (1990). MINIM: A Program for Randomising Patients to Treatment Groups in Clinical Trials by the Method of Minimisation. Version 1.5. Guy’s Hospital : London.
  15. (1999). National Service Frameworks for Mental Health. Modern Standards and Service Models. Department of Health: London. doi
  16. (1993). Non-compliance – or how many aunts has Matilda? doi
  17. (1988). Non-psychotic psychiatric disorder after childbirth: a prospective study of prevalence, incidence, course and nature. doi
  18. (1995). Office of Population Censuses & Surveys Social Survey Division. doi
  19. (1992). Open Teaching Toolkit : Effective Tutorials. The Open University : Milton Keynes.
  20. (1988). Parents groups in pregnancy. A preventative intervention for postnatal depression?
  21. (2000). Preparing for parenthood: background and development of a risk modifying intervention to prevent postnatal depression. Archives of Women’s Mental Health (in the press). doi
  22. (1998). Prevention of postnatal depression by brief antenatal intervention. The development and evaluation by randomised controlled trial of a new psychosocial intervention. Unpublished report to the NHS Executive National R&D programme,
  23. (1998). Prevention of postpartum depression and adjustment difficulties in high risk women. Biennial Meeting of the Marce Society,
  24. (1998). Prevention of postpartum depression in high-risk women.
  25. (1996). Rates and risk of postpartum depression – a meta-analysis. doi
  26. (1989). Ratings of social support by adolescents and adult informants : degree of correspondence and prediction of depressive symptoms. doi
  27. (1992). Recognition and management of depression in general practice : consensus statement.BritishMedical doi
  28. (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. National Academy of Medicine: doi
  29. (1972). Regressionmodels and life tables (with discussion).
  30. (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry.
  31. (1960). Social factors in prevention of post partum emotional adjustment. doi
  32. (1995). Social support and psychiatric disorder : recommendations for clinical practice and research. doi
  33. (1995). Social Support and Psychiatric Disorder: Research Findings and Guidelines for Clinical Practice. doi
  34. (1995). Social support processes and cognitive therapy. doi
  35. (1998). Socioeconomic status, standard of living and neurotic disorder. doi
  36. (1998). support and the development of postnatal depressive symptoms, a prospective cohort survey. doi
  37. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents : a randomized trial of a group cognitive intervention. doi
  38. (1992). The cause, morbidity and costs of depression. doi
  39. (1982). The development and implications of a personal problem-solving inventory. doi
  40. (1996). The impact of postnatal depression and associated adversity on early mother–infant interactions and later infant outcome. doi
  41. (1990). The interval General Health Questionnaire. doi
  42. (1987). The Interview Measure of Social Relationships : the description and evaluation of a survey instrument for assessing personal social resources. doi
  43. (1998). The Leicester Housing Schedule : Background and Questionnaire Format. Working paper,
  44. (1985). The List of Threatening Experiences : a subset of 12 life event categories with considerable long-term contextual threat : doi
  45. (1990). The List of Threatening Experiences : the reliability and validity of a brief life events questionnaire. doi
  46. (1997). The NCT.
  47. (1993). Two-year follow-up of skills training with mothers of children with disabilities.
  48. (1990). World Health Organization Division of Mental Health doi

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