Interpersonal counselling versus perinatal-specific cognitive behavioural therapy for women with depression during pregnancy offered in routine psychological treatment services: a phase II randomised trial

Jonathan Evans,Jenny Ingram,Roslyn Law,Joel Glynn,Hazel Taylor,David Kessler,Heather O’Mahen,Iryna Culpin,Jeff Round,Becky Hopley,Debbie Johnson,Jenny Ford

doi:10.1186/s12888-021-03482-x

Abstract

BackgroundUp to one in eight women experience depression during pregnancy. In the UK, low intensity cognitive behavioural therapy (CBT) is the main psychological treatment offered for those with mild or moderate depression and is recommended during the perinatal period, however referral by midwives and take up of treatment by pregnant women is extremely low.Interpersonal Counselling (IPC) is a brief, low-intensity form of Interpersonal Psychotherapy (IPT) that focuses on areas of concern to service users during pregnancy.To improve psychological treatment for depression during pregnancy, the study aimed to assess the feasibility and acceptability of a trial of IPC for antenatal depression in routine NHS services compared to low intensity perinatal specific CBT.MethodsWe conducted a small randomised controlled trial in two centres. A total of 52 pregnant women with mild or moderate depression were randomised to receive 6 sessions of IPC or perinatal specific CBT. Treatment was provided by 12 junior mental health workers (jMHW). The primary outcome was the number of women recruited to the point of randomisation. Secondary outcomes included maternal mood, couple functioning, attachment, functioning, treatment adherence, and participant and staff acceptability.ResultsThe study was feasible and acceptable. Recruitment was successful through scanning clinics, only 6 of the 52 women were recruited through midwives. 71% of women in IPC completed treatment. Women reported IPC was acceptable, and supervisors reported high treatment competence in IPC arm by jMHWs. Outcome measures indicated there was improvement in mood in both groups (Change in EPDS score IPC 4.4 (s.d. 5.1) and CBT 4.0 (s.d. 4.8).ConclusionsThis was a feasibility study and was not large enough to detect important differences between IPC and perinatal specific CBT. A full-scale trial of IPC for antenatal depression in routine IAPT services is feasible.Trial registrationThis study has been registered with ISRCTN registry 11513120. – date of registration 05/04/2018.

Highlights

Up to one in eight women experience depression during pregnancy
There are important limitations of cognitive behavioural therapy (CBT) for pregnancy as a model for less experienced therapists because: 1) without adaptation and additional training, CBT has few explicit strategies to manage many of the problems that are common for women with antenatal depression, including role transitions and problems in communication
This is critical as conflict in relationships and poor social support are the strongest risk factors for antenatal depression (Lancaster [8]). 2) low intensity CBT does not manage problems with grief that contributes to depressive symptoms

Summary

Introduction

Up to one in eight women experience depression during pregnancy. In the UK, low intensity cognitive behavioural therapy (CBT) is the main psychological treatment offered for those with mild or moderate depression and is recommended during the perinatal period, referral by midwives and take up of treatment by pregnant women is extremely low. There are important limitations of CBT for pregnancy as a model for less experienced therapists because: 1) without adaptation and additional training, CBT has few explicit strategies to manage many of the problems that are common for women with antenatal depression, including role transitions and problems in communication. This is critical as conflict in relationships and poor social support are the strongest risk factors for antenatal depression (Lancaster [8]). This is critical as conflict in relationships and poor social support are the strongest risk factors for antenatal depression (Lancaster [8]). 2) low intensity CBT does not manage problems with grief (i.e., miscarriage, still-birth, termination, loss of parents at time of birth of child) that contributes to depressive symptoms. 3) CBT is not designed to involve the partner

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