A multifaceted approach to postnatal depression, including psychoeducational groups and treatment adherence support, helps mothers with postnatal depression in low income settings recover more quickly than conventional care. These are the conclusions of authors of an article published in this week's Latin America special edition of The Lancet.
Professor Ricardo Araya, Academic Unit of Psychiatry, University of Bristol, UK, and colleagues studied 230 mothers with major depression attending postnatal clinics in Santiago, Chile. Of these, 114 were randomly assigned to the multicomponent intervention group, which involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. The other 116 patients were given the standard care normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for speciality treatment. Each patient was then assessed using the Edinburgh postnatal depression scale (EPDS) at three months and six months after randomisation, in which lower scores mean the patient is less depressed.
The researchers found the crude mean EPDS score was lower for the multicomponent intervention group than for the standard care group at three months (8.5 versus 12.8). Although these differences decreased by six months, the EPDS score remained better (ie. lower) in the multicomponent intervention group compared with the standard care group (10.9 versus 12.5).
The authors say: "Our study has shown large and significant clinical improvements in low-income mothers with postnatal depression of moderate or greater severity who were allocated to multicomponent intervention compared with those in the usual care group; this study suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in some resource-poor countries."
They conclude: "Since so many health programmes in developing countries are focused around the perinatal period, this study provides a great opportunity to find ways of improving the recognition and treatment of postnatal depression and reducing its adverse effect of women and their children."
In an accompanying Comment, Dr Rhonda Small and Dr Judith Lumley, Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia, say: "Araya and colleagues contribute to existing evidence and provide food for thought about the remaining challenges; despite a great deal of research in the past two decades, we still have much to learn about the design and implementation of effective, acceptable, and sustainable strategies for improving the mental health of women after childbirth."
Professor Ricardo Araya, Academic Unit of Psychiatry, University of Bristol, UK T) +44 117 954 6702 E) R.Araya@bristol.ac.uk
Dr Rhonda Small, Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia T) +61 3 434 027 760 E) R.Small@latrobe.edu.au
The paper associated with the press release is listed below:
http://multimedia.thelancet.com/pdf/press/Postnatal.pdf
Journal
The Lancet