Psychological approaches to preventing depression in pregnancy

Project Duration

September 2009 - August 2012

Funder

NIHR LINR CLAHRC

Aims

Repeated epidemiological surveys show no evidence of decline in depression although uptake of treatments has grown. Universal depression prevention interventions are occasionally effective in school settings but untested rigorously in adulthood. Selective prevention programmes are subject to poor uptake. Universal interventions may be more acceptable during routine healthcare contacts for example antenatally. One study within routine postnatal healthcare suggested risk of depression could be reduced from 11% to 8% but feasibility and effectiveness in other settings, most notably antenatally, is unknown. Our aim was to test the feasibility of training community midwives to assess depressive symptoms during pregnancy and provide sessions based on an established psychological approach to supporting women already at risk of depression whilst reducing future risk of depression in women not at immediate risk.

Methods

We conducted an external pilot study using a cluster trial design consisting of recruitment and enhanced psychological training of randomly selected clusters of community midwives (CMW), recruitment of pregnant women of all parity and risk of depression, collection of baseline and outcome data prior to childbirth, allowing time for women at increased risk to complete psychological support sessions provided by their CMW.

Outcomes and Findings

83% of eligible women approached agreed to take part. 299 women in eight clusters participated and 186 termed ‘at low risk’ for depression based on an Edinburgh Perinatal Depression Scale (EPDS) <12 at 12 weeks gestation provided baseline and outcome data at 34 weeks gestation. All trial protocol procedures were shown to be feasible. Antenatal effect sizes were similar to those previously demonstrated postnatally. Qualitative work confirmed the acceptability of the approach to CMWs and intervention group women. Conclusion: A fully powered trial testing universal prevention of depression in pregnancy is feasible, acceptable and worth undertaking.

Publications

Journal article submitted for publication. Project report: Brugha, T. S., Slade, P., Smith, J., Bankart, J., Patterson, M., Austin, J., Morgan, Z., Lovett, C., & Morrell, J. 2012, Pregnancy and wellbeing study PAWs pilot report, ISRCTN72346869., LNR CLAHRC, Leicester.