Stress debriefing after childbirth: a randomised controlled trial.

OBJECTIVE

To test whether critical incident stress debriefing after childbirth reduces the incidence of postnatal psychological disorders.

DESIGN

Randomised single-blind controlled trial stratified for parity and delivery mode.

SETTING

Two large maternity hospitals in Perth.

PARTICIPANTS

1745 women who delivered healthy term infants between April 1996 and December 1997 (875 allocated to intervention and 870 to control group).

INTERVENTION

An individual, standardised debriefing session based on the principles of critical incident stress debriefing carried out within 72 hours of delivery.

MAIN OUTCOME MEASURES

Diagnosis of stress disorders or depression in the 12 months postpartum, using structured psychological interview and criteria of the Diagnostic and statistical manual of mental disorders, 4th edition.

RESULTS

Follow-up information was available for 1730 women (99.1%), 482 of whom underwent psychological interview. There were no significant differences between control and intervention groups in scores on Impact of Events or Edinburgh Postnatal Depression Scales at 2, 6 or 12 months postpartum, or in proportions of women who met diagnostic criteria for a stress disorder (intervention, 0.6% v control, 0.8%; P = 0.58) or major or minor depression (intervention, 17.8% v control, 18.2%; relative risk [95% CI], 0.99 [0.87-1.11]) during the postpartum year. Nor were there differences in median time to onset of depression (intervention, 6 [interquartile range, 4-9] weeks v control, 4 [3-8] weeks; P = 0.84), or duration of depression (intervention, 24 [12-46] weeks v control, 22 [10-52] weeks; P = 0.98).

CONCLUSIONS

There is a high prevalence of depression in women during the first year after childbirth. A session of midwife-led, critical incident stress debriefing was not effective in preventing postnatal psychological disorders, but had no adverse effects.