Preventing postnatal depression in mothers of very preterm infants: a randomised controlled trial.

OBJECTIVE: To test whether a cognitive-behaviour therapy intervention program reduces the prevalence of depression during the first postnatal year in mothers of very preterm babies. DESIGN: Prospective, single blind, randomised, controlled study. SETTING: Perinatal centre in Western Australia. PARTICIPANTS: One hundred and ninety-nine out of 673 English-speaking mothers of infants admitted to the neonatal unit. INTERVENTION: A six-session cognitive-behaviour therapy intervention program provided by a research midwife between weeks two and six after birth. Women in the control group received standard care. MAIN OUTCOME MEASURES: Depression and anxiety disorders occurring in the first year assessed by a clinical psychologist at structured interview using the Schedule for Affective Disorders and Schizophrenia (SADS) at 2 weeks, 2, 6 and 12 months. RESULTS: One hundred and one women were randomised to the intervention group and 98 to the control group. Fifty-four mothers (27%) in the trial were diagnosed with minor or major depression in the 12 months following very preterm delivery, 29 (29%) in the intervention group and 25 (26%) in the control group (relative risk 1.1 [95% CI 0.80-1.5]). There were no differences in the time of onset or the duration of the episodes of depression between the groups. Overall, 74 mothers (37%) of the 199 met criteria for a diagnosis of psychological morbidity during the first year. CONCLUSIONS: Our intervention program did not alter the prevalence of depression in these mothers. Rates of depression and stress reactions are high in these mothers.

To screen or not to screen--that is the question in perinatal depression.

Significant perinatal distress and depression affects 14% of women, producing short and long term consequences for the family. This suggests that measures for early detection are important, and non-identification of these women may exacerbate difficulties. Screening provides an opportunity to access large numbers of women and facilitate pathways to best-practice care. A valid, reliable, economical screening tool (the Edinburgh Postnatal Depression Scale, EPDS) is available. Arguments against screening pertain largely to lack of evidence about the acceptability of routine use of the EPDS during pregnancy and the postnatal period, and inadequate evidence regarding outcomes and cost-effectiveness. To address these concerns, the National Postnatal Depression Prevention and Early Intervention Program will evaluate outcomes of screening in terms of acceptability, cost-effectiveness, access and satisfaction with management in up to 100 000 women.