Abstract
Repeated epidemiological surveys show no decline in depression although uptake of treatments has grown. Universal depression prevention interventions are effective in schools but untested rigorously in adulthood. Selective prevention programmes have poor uptake. Universal interventions may be more acceptable during routine healthcare contacts for example antenatally. One study within routine postnatal healthcare suggested risk of postnatal depression could be reduced in non-depressed women from 11% to 8% by giving health visitors psychological intervention training. Feasibility and effectiveness in other settings, most notably antenatally, is unknown. We conducted an external pilot study using a cluster trial design consisting of recruitment and enhanced psychological training of randomly selected clusters of community midwives (CMWs), recruitment of pregnant women of all levels of risk of depression, collection of baseline and outcome data prior to childbirth, allowing time for women 'at increased risk' to complete CMW-provided psychological support sessions. Seventy-nine percent of eligible women approached agreed to take part. Two hundred and ninety-eight women in eight clusters participated and 186 termed 'at low risk' for depression, based on an Edinburgh Perinatal Depression Scale (EPDS) score of <12 at 12 weeks gestation, provided baseline and outcome data at 34 weeks gestation. All trial protocol procedures were shown to be feasible. Antenatal effect sizes in women 'at low risk' were similar to those previously demonstrated postnatally. Qualitative work confirmed the acceptability of the approach to CMWs and intervention group women. A fully powered trial testing universal prevention of depression in pregnancy is feasible, acceptable and worth undertaking.
Highlights
Depression continues to be a leading cause of disability (Murray et al 2012) worldwide: the Global Burden of Disease (GBD) studies underlined the ‘large unrecognized burden of mental illness in developed and developing countries – 8.5% of disability adjusted life years (DALYs) in the GBD 1990 study and 10.1% in the GBD 2000 study’
We conducted an external pilot study using a cluster trial design consisting of recruitment and enhanced psychological training of randomly selected clusters of community midwives (CMWs), recruitment of pregnant women of all levels of risk of depression, collection of baseline and outcome data prior to childbirth, allowing time for women ‘at increased risk’ to complete CMW-provided psychological support sessions
Qualitative work confirmed the acceptability of the approach to CMWs and intervention group women
Summary
Depression continues to be a leading cause of disability (Murray et al 2012) worldwide: the Global Burden of Disease (GBD) studies underlined the ‘large unrecognized burden of mental illness in developed and developing countries – 8.5% of disability adjusted life years (DALYs) in the GBD 1990 study and 10.1% in the GBD 2000 study’. Randomized controlled trial (RCT) evidence shows that pharmacological and psychological interventions can be recommended for depression (NICE, 2009). Despite this and evidence of increased uptake of depression treatments, epidemiological studies monitoring rates of depression at a population level show no evidence of decline in depression prevalence (Brugha et al 2004; Kessler et al 2005; Compton et al 2006; Spiers et al 2012). Factors other than treatment may explain trends in depression rates, we argue innovative. Feasibility and effectiveness in other settings, most notably antenatally, is unknown
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