New RCT reports a promising primary care solution to diagnosing and managing postnatal depression

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Postnatal (or postpartum) depression is moderate to severe depression that affects women just after they have given birth. It’s a relatively common illness, affecting 7-15% of childbearing women.

Suffering from depression in the first few weeks of motherhood can have a significant impact, not just on the health of the mother, but also on her relationship with her new child and the neurodevelopment of the baby.

A new study in the Annals of Family Medicine looks at ways in which we can improve the diagnosis and management of postnatal depression. The research is a cluster randomised controlled trial involving 28 primary care practices in the US. The practices were randomised, so half of them continued with their usual care and the other half delivered a new practice-wide intervention involving screening, diagnosis, evaluation and management of postnatal depression. Staff in the practices delivering the new intervention were trained and given tools and resources to help with patient follow-up. The intervention was specifically designed to maintain most of the care within the local practice, reserving referral for complicated cases or unresponsive depression.

The primary outcome (a reduction in postnatal depression) was measured with two self-report checklists:

  1. Edinburgh Postnatal Depression Scale (EPDS)
  2. Patient Health Questionnaire PHQ-9

Here’s what they found:

  • At baseline, just over a third (34.5%) of women included in the analysis had high screening scores, which indicated postnatal depression. Rates of depression were similar in the control and intervention groups
  • The women who received the intervention:
    • Were more likely to receive a diagnosis of postnatal depression (P = .0006)
    • Were more likely to receive therapy for postpartum depression (P = .002)
    • Had lower depressive symptom levels at 6 months (P = .07) and 12 months (P=.001)

The authors concluded that:

Primary care–based screening, diagnosis, and management improved mother’s depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.

There are a couple of key limitations worth highlighting:

  • Clearly the patients and practices could not be blinded to the treatment being given, but the outcome assessors could and it’s unclear from the study if this was the case
  • Nearly a third of women in the intervention group had medical insurance that only covered them for 2 months after having their baby. This is perhaps typical of healthcare in the US, but might make the study findings less generalisable to the UK where primary care is delivered quite differently.

Link

Yawn BP, Dietrich AJ, Wollan P, et al. TRIPPD: A practice-based network effectiveness study of postpartum depression screening and management. Ann Fam Med 2012; 10:320–9.

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