Fisher Jane, Tran Thach, Wynter Karen, Hiscock Harriet, Bayer Jordana, Rowe Heather
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Murdoch Childrens Research Institute, Victoria, Australia.
Glob Ment Health (Camb). 2018 Sep 25;5:e30. doi: 10.1017/gmh.2018.20. eCollection 2018.
What Were We Thinking (WWWT) is a gender-informed, psychoeducational programme to promote respectful relationships and skilled management of unsettled infant behaviours and thereby reduce postpartum common mental disorders. It comprises a highly structured seminar for couples and babies, usual primary care from a WWWT-trained nurse and take-home print materials. The aim was to assess long-term outcomes after a cluster randomised controlled trial of WWWT.
Trial participants who consented completed a computer-assisted telephone interview 18 months postpartum. Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9) and anxiety symptoms with the Generalised Anxiety Disorder Scale (GAD-7). Impacts of baseline characteristics and trial arm on changes in scores from baseline to follow-up were calculated using Conditional Latent Growth Curve Models adjusting for prognostic indicators and controlling for clustering effects.
Overall, 314/400 (78.5%) women contributed data at baseline (6 weeks postpartum), trial endline (26 weeks postpartum) and follow-up (12 months after trial endline). In intention-to-treat analyses, there was a significantly greater improvement in adjusted GAD-7 scores [regression coefficient (RC) -0.55; 95% confidence interval (CI) -0.94 to -0.17] and non-significant improvement (RC -0.27; 95% CI -0.63 to 0.08) in PHQ-9 scores from baseline to follow-up in the intervention than the control arm. In a per-protocol analysis, the proportion with GAD-7 scores ⩽4 (asymptomatic) improved 24.1% (55.7% baseline to 79.8% follow-up, = 0.043) among women who received the full WWWT programme, which included the seminar, compared with 2.4% (77.1-79.5%, = 0.706) among those who received the partial intervention (usual care from WWWT-trained nurse and print materials).
The WWWT programme has a significant sustained beneficial impact on postnatal generalised anxiety among primiparous women compared with usual care. The in-person seminar is the most influential component of the intervention. Psycho-educational programmes integrated into primary care appear promising as a strategy to reduce postpartum common mental disorders.
“我们当时在想什么”（WWWT）是一项关注性别的心理教育项目，旨在促进建立相互尊重的关系，并熟练应对婴儿难以安抚的行为，从而减少产后常见精神障碍。该项目包括为夫妻和婴儿举办的一场结构严谨的研讨会、由接受过WWWT培训的护士提供的常规初级护理以及带回家的印刷材料。目的是评估在对WWWT进行整群随机对照试验后的长期结果。
同意参与试验的参与者在产后18个月完成了一次计算机辅助电话访谈。使用患者健康问卷（PHQ - 9）评估抑郁症状，使用广泛性焦虑障碍量表（GAD - 7）评估焦虑症状。使用条件潜在增长曲线模型计算基线特征和试验组对从基线到随访期间分数变化的影响，该模型对预后指标进行了调整并控制了聚类效应。
总体而言，314/400（78.5%）名女性在基线（产后6周）、试验终点（产后26周）和随访（试验终点后12个月）时提供了数据。在意向性分析中，与对照组相比，干预组从基线到随访期间调整后的GAD - 7分数有显著更大的改善[回归系数（RC） - 0.55；95%置信区间（CI） - 0.94至 - 0.17]，而PHQ - 9分数有非显著改善（RC - 0.27；95% CI - 0.63至0.08）。在符合方案分析中，接受完整WWWT项目（包括研讨会）的女性中，GAD - 7分数≤4（无症状）的比例从基线时的55.7%提高到随访时的79.8%，改善了24.1%（P = 0.043），而接受部分干预（由接受过WWWT培训的护士提供常规护理和印刷材料）的女性中这一比例为2.4%（从77.1%到79.5%，P = 0.706）。
与常规护理相比，WWWT项目对初产妇产后广泛性焦虑有显著的持续有益影响。面对面的研讨会是干预措施中最具影响力的组成部分。纳入初级护理的心理教育项目作为减少产后常见精神障碍的一种策略似乎很有前景。
