Abstract
BackgroundPostnatal depression (PND) is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND) following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs) alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT), delivered by postnatal nurses or psychologists.MethodsThis was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres) and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups.ResultsMean scores on the Beck Depression Inventory (BDI-II) at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028). However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%), and subsequent treatment uptake (40%) were low.ConclusionsData from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research.Trial RegistrationThe study is registered at ClinicalTrials.gov, Trial Registration Number NCT01002027.
Highlights
Postnatal depression (PND) is under-diagnosed and most women do not access effective help
Twenty-three women were allocated to Group A (GP management), to Group B and to Group C
Mean baseline scores on the BDI-II were in the moderate to severe range for all groups indicating the presence of clinically significant depressive symptoms
Summary
Postnatal depression (PND) is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND) following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs) alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT), delivered by postnatal nurses or psychologists. Whilst CBT is generally delivered by mental health specialists such as psychologists, some evidence for the ability of nurses to deliver psychological interventions for PND in primary care has been published. Studies conducted to date have not explicitly compared such interventions to management by GPs. To our knowledge, in the postnatal period, five controlled trials have evaluated psychologically-informed interventions delivered by primary care practitioners (generally nurses) [10,11,12,13,14]. Cooper et al [10] found an expertise effect, such that women treated by non-specialists showed significantly greater reduction in depressive symptoms compared with those treated by specialists ( treatment allocation was not randomised)
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