Postnatal Depression

Health visitor delivered psycho­therapy for post-natal depression

Depression affects about 13% of women in the year after delivery. Now a UK trial in general prac­tice has shown benefit from interventions by health visitors.

A total of 2,749 women were enrolled an­tenatally at 101 general practices and randomized
(2:1) to intervention or control groups. In the intervention group, specially trained health visi­tors identified symptoms of depression using the Edinburgh post-natal depression scale (EPDS) and clinical assessment, and provided therapy (either cognitive behavioural therapy or person-centred therapy) in sessions lasting for an hour, each week for 8 weeks. The control group had usual care. At 6 weeks after delivery, 595 women had an EPDS score of at least 12. Of 418 of these women reas­sessed at 6 months, 93/271 (34%) in the interven­tion group and 67/147 (46%) in the control group had a score of at least 12, a significant 38% reduc­tion in prevalence in the intervention group. In the total cohort, the prevalence of a score of at least 12 at 6 months was 12.4% (intervention) versus 16.7% (control), a significant 33% difference. The benefit was maintained at 12 months. There was no dif­ference in outcome with cognitive behavioural or person-centred therapy.

Therapy provided by trained health visitors was successful.

Morrell CJ, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 2009;338:276– 280; Dennis C-L. Preventing and treating postnatal depression. Ibid:246– 247 (editorial).

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