Abstract
BackgroundUniversal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorised, not gender-informed and overlooked relevant risk factors. This study aimed to determine whether an innovative brief psycho-educational program for mothers, fathers and first newborns, which addressed salient learning needs about infant behaviour management and adjustment tasks in the intimate partner relationship, prevented postpartum mental health problems in primiparous women.MethodsA before and after controlled study was conducted in primary care in seven local government areas in Victoria, Australia. English-speaking couples with one-week old infants were invited consecutively to participate by the maternal and child health nurse at the universal first home visit. Two groups were recruited and followed sequentially: both completed telephone interviews at four weeks and six months postpartum and received standard health care. Intervention group participants were also invited to attend a half-day program with up to five couples and one month old infants, facilitated by trained, supervised nurses. The main outcome was any Composite International Diagnostic Interview (CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors associated with the outcome were established by logistic regression controlling for potential confounders and analysis was by intention to treat.ResultsIn total 399/646 (62%) women were recruited; 210 received only standard care and 189 were also offered the intervention; 364 (91%) were retained at follow up six months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%) were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107 (15%) in the intervention group. In those without a psychiatric history, the adjusted odds ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in the intervention group compared to the control group.ConclusionsA universal, brief psycho-educational group program for English-speaking first time parents and babies in primary care reduces de novo postpartum mental disorders in women. A universal approach supplemented by an additional program may improve effectiveness for women with a psychiatric history.Trial registrationACTRN 12605000567628.
Highlights
Universal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorised, not gender-informed and overlooked relevant risk factors
Setting The study was conducted in seven local government areas (LGAs) in the Australian state of Victoria
Diverse LGAs were selected by Socio-Economic Indices for Areas (SEIFA) to represent a range of areas across the spectrum of socioeconomic advantage and disadvantage [56]; three were from rural Victoria and four were in metropolitan Melbourne
Summary
Universal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorised, not gender-informed and overlooked relevant risk factors. Nature and prevalence of postpartum mental health problems The predominant focus of research, policy initiatives, clinical practice recommendations and health education has been postnatal depression, but there is increasing evidence that postnatal anxiety disorders are at least as common, but less well recognised than depression [4,5]. Brockington [1] in a review of postnatal psychiatric disorders concludes that women identified through screening as depressed have heterogeneous conditions including posttraumatic stress disorder, panic, phobic, obsessional and generalised anxiety disorders, adjustment disorders and depression. These are situationfocused, disabling and often reflect adversity [6]. Brockington [1] argues that ‘postnatal depression’ has value as a lay term, but is imprecise as a clinical or a research construct
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