Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care



Brugha, TS, Morrell, CJ, Slade, P ORCID: 0000-0001-5877-2706 and Walters, SJ
(2011) Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychological Medicine, 41 (4). 739 - 748.

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Abstract

<jats:sec id="S0033291710001467_sec_001"><jats:title>Background</jats:title><jats:p>To test whether receiving care from a health visitor (HV) trained in identification and psychological intervention methods prevents depression 6–18 months postnatally in women who are not depressed 6 weeks postnatally.</jats:p></jats:sec><jats:sec id="S0033291710001467_sec_a002"><jats:title>Method</jats:title><jats:p>The study was a prospective cluster trial, randomized by GP practice, with follow-up for 18 months in 101 primary care teams in the Trent area of England. The participants were women scoring &lt;12 on the postal Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postnatally (1474 intervention and 767 control women). Intervention HVs (<jats:italic>n</jats:italic>=89, 63 clusters) were trained in identifying depressive symptoms using the EPDS and face-to-face clinical assessment and in providing psychologically orientated sessions based on cognitive behavioral or person-centered principles. The control group comprised HVs (<jats:italic>n</jats:italic>=49, 37 clusters) providing care as usual (CAU). The primary outcome measure was the proportion of women scoring ⩾12 on the EPDS at 6 months postnatally. Secondary outcomes were mean EPDS score, Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) score, State–Trait Anxiety Inventory (STAI), 12-item Short Form Health Survey (SF-12) and Parenting Stress Index Short Form (PSI-SF) scores at 6, 12 and 18 months.</jats:p></jats:sec><jats:sec id="S0033291710001467_sec_a003" sec-type="results"><jats:title>Results</jats:title><jats:p>After adjusting for individual-level covariates, living alone, previous postnatal depression (PND), the presence of one or more adverse life events and the 6-week EPDS score, the odds ratio (OR) for EPDS ⩾12 at 6 months was 0.71 [95% confidence interval (CI) 0.53–0.97, <jats:italic>p</jats:italic>=0.031] for the intervention group (IG) women compared with the control (CAU) group women. Two subgroups were formed by baseline severity: a ‘subthreshold’ subgroup with a 6-week EPDS score of 6–11 (<jats:italic>n</jats:italic>=999) and a ‘lowest severity’ subgroup with a 6-week EPDS score of 0–5 (<jats:italic>n</jats:italic>=1242). There was no difference in psychological effectiveness by subgroup (interaction term: <jats:italic>z</jats:italic>=−0.28, <jats:italic>p</jats:italic>=0.782).</jats:p></jats:sec><jats:sec id="S0033291710001467_sec_a004" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>This study provides new evidence of a universal, enduring preventive effect for depression in women who screen negative for depression postnatally.</jats:p></jats:sec>

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 11 Aug 2016 08:28
Last Modified: 03 Mar 2021 10:23
DOI: 10.1017/s0033291710001467
URI: https://livrepository.liverpool.ac.uk/id/eprint/3002865