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

BMC Psychiatry

Research Article

Jeannette Milgrom¹  Anne Buist²  Jennifer Ericksen³  Christopher J Holt³  Charlene Schembri³  Bronwyn Leigh³  Alan W Gemmill³ 

[1] Department of Psychology, Psychological Sciences, University of Melbourne, 3010, Victoria, Australia;Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, 3081, Heidelberg West, Victoria, Australia;Northpark Hospital, Victoria, Australia;Department of Medicine, University of Melbourne, Victoria, Australia;Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, 3081, Heidelberg West, Victoria, Australia;

关键词: Depressive Symptom;    Cognitive Behavioural Therapy;    Edinburgh Postnatal Depression Scale;    Postnatal Depression;    Primary Care Professional;   

DOI  :  10.1186/1471-244X-11-95

 received in 2010-11-12, accepted in 2011-05-27,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Milgrom et al; licensee BioMed Central Ltd. 2011