Brugha T S, Wheatley S, Taub N A, Culverwell A, Friedman T, Kirwan P, Jones D R, Shapiro D A
Department of Psychiatry, University of Leicester.
Psychol Med. 2000 Nov;30(6):1273-81. doi: 10.1017/s0033291799002937.
Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention.
We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. 'Preparing for Parenthood', a structured antenatal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview.
Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1.22 (95% CI 0.63-2.39), P = 0.55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders.
Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation.
社会支持理论和观察性风险因素研究表明，增加产前心理社会支持可预防产后抑郁症。我们运用了此前未使用过的产后抑郁症风险和保护因素的实证知识，来开发和评估一种产前预防性干预措施。
我们在产前诊所进行了一项实用随机对照试验。我们对1300名初产妇进行了筛查，400名筛查呈阳性，69名筛查呈阳性的女性无法追踪或不符合条件。在292名完成基线评估的女性中，209名同意随机分组，其中190名在产后3个月提供了结局数据。将“为为人父母做准备”（一项旨在增加社会支持和解决问题能力的结构化产前风险因素降低干预措施）与仅进行常规产前护理进行比较。我们使用自我完成的一般健康问卷抑郁量表、爱丁堡产后抑郁量表（EPDS）以及神经精神病学临床评估日程表（一种系统的临床访谈），比较了产后3个月时抑郁的百分比。
分配到干预组对产后抑郁症（一般健康问卷抑郁量表的优势比为1.22（95%可信区间0.63 - 2.39），P = 0.55）或抑郁风险因素没有显著影响。干预组中有45%的女性参加了足够的课程，如果有效，她们可能会从干预中受益。参加者受益并不比未参加者更多。
在进一步研究证明此类方法的可行性和有效性之前，针对产后抑郁症的预防服务不应按照这些思路实施产前支持计划。在进行进一步的试验评估之前，应完成有效降低风险因素的新型低成本干预措施的开发。
