Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's Health Research Chair, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
Associate Professor of Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto; and Head, Woman's Mood and Anxiety Clinic: Reproductive Transitions, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
Br J Psychiatry. 2020 Apr;216(4):189-196. doi: 10.1192/bjp.2019.275.
Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers.
To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377.
Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality.
At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10-0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14-0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks.
Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.
产后抑郁和焦虑是未得到充分重视的公共卫生问题，存在许多治疗可及性障碍，包括心理健康专家资源不足。
评估护士提供的电话人际心理治疗（IPT）对产后抑郁的疗效。试验注册 ISRCTN88987377。
来自加拿大 36 个农村和城市地区的 36 个公共卫生区域的 241 名产后抑郁妇女（DSM-IV 结构临床访谈（SCID-I）确诊为重度抑郁）被随机分配到每周 12 次、每次 60 分钟的护士提供的电话 IPT 治疗组或标准的当地可获得的护理组。主要结局是在随机分组后 12 周时患有临床抑郁的女性比例，采用盲法意向治疗分析。次要结局包括共病焦虑、自我报告的依恋和伴侣关系质量。
在 12 周时，IPT 组（11/104）中有 10.6%的女性和对照组（35/100）中有 35%的女性仍然抑郁（OR=0.22，95%CI 0.10-0.46），IPT 组的临床抑郁（SCID）可能性低 4.5 倍；IPT 组有 21.2%的人，对照组有 51%的人爱丁堡产后抑郁量表（EPDS）评分>12（OR=0.26，95%CI 0.14-0.48），IPT 组的回避依恋程度比对照组下降更多（P=0.02）。在所有时间点，IPT 组在共病焦虑和伴侣关系质量方面均优于对照组，在卫生服务或抗抑郁药使用方面无差异。IPT 组的应答者在 36 周时均无复发。组间 SCID 差异在 24 周时持续存在，但在 36 周时不再存在。
护士提供的电话 IPT 是一种有效的治疗产后抑郁和焦虑的方法，可改善治疗的可及性差距，适用于不同城市和农村地区的女性。
