Early Childhood Nurse-Delivered Cognitive Behavioural Counselling for Post-Natal Depression

Abstract

Objective: The aims were (1) to establish whether Early Childhood Nurses (ECNs) can be trained in a modified Cognitive Behavioural Therapy (CBT) for Post-natal Depression (PND), and (2) to compare the outcome of women treated with this therapy with ‘ideal standard care’ using non-specific counselling by ECNs with no additional training. Method: Five ECNs were trained in CBT and supervised weekly. Women were screened post-natally using the Edinburgh PND Scale (EPDS) and diagnostically assessed by a research registrar. Women with DSM-IV major or minor depression (n=37) were then randomized into either ‘ideal standard care’ (n=20) or CBT (n=17) for six weekly sessions. Two stages of follow-up were undertaken: research registrar interview immediately post-treatment and a postal follow-up at six months. Results: The training package was evaluated both by ECN completed questionnaires and analysis of taped therapy sessions. These evaluations indicated that ECNs could deliver modified CBT. There was a very high rate of recovery at initial follow-up with 70-80% recovered (EPDS < 10) in both groups. Six month follow-up showed a trend towards CBT being more effective in the longer term. Conclusions: ECNs can effectively provide a modified CBT intervention in the treatment of PND. For the majority of this sample with mild-moderate depression, perceived support from their ECN (forming an integral part of both the baseline assessment interview and control condition) appeared to be as effective as modified CBT.