Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling

Jeannette Milgrom, Christopher J Holt, Alan W Gemmill, Jennifer Ericksen, Bronwyn Leigh, Anne Buist, Charlene Schembri, Jeannette Milgrom, Christopher J Holt, Alan W Gemmill, Jennifer Ericksen, Bronwyn Leigh, Anne Buist, Charlene Schembri

Abstract

Background: 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.

Methods: This 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.

Results: Mean 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.

Conclusions: Data 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 registration: ClinicalTrials.gov NCT01002027.

Figures

Figure 1
Figure 1
Participant Flowchart.
Figure 2
Figure 2
Changes in Symptoms of Depression and Anxiety. a) Beck Depression Inventory II; b) DASS 21 SF Anxiety Sub-scale. For each measure the means of the three groups are plotted across time. Only those cases with complete data are shown:- Group A (GP management), n = 12; Group B (Counselling-CBT with nurse), n = 12; Group C (Counselling-CBT with psychologist), n = 12. Error bars are ± 1 SE.

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Source: PubMed

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