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Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: I. Impact on maternal mood

  • Peter J. Cooper (a1), Lynne Murray (a1), Anji Wilson (a2) and Helena Romaniuk (a1)

Abstract

Background

Psychological interventions for postnatal depression can be beneficial in the short term but their longer-term impact is unknown.

Aims

To evaluate the long-term effect on maternal mood of three psychological treatments in relation to routine primary care.

Method

Women with post-partum depression (n=193) were assigned randomly to one of four conditions: routine primary care, non-directive counselling, cognitive–behavioural therapy or psychodynamic therapy. They were assessed immediately after the treatment phase (at 4.5 months) and at 9, 18 and 60 months post-partum.

Results

Compared with the control, all three treatments had a significant impact at 4.5 months on maternal mood (Edinburgh Postnatal Depression Scale, EPDS). Only psychodynamic therapy produced a rate of reduction in depression (Structured Clinical Interview for DSM–III–R) significantly superior to that of the control. The benefit of treatment was no longer apparent by 9 months post-partum. Treatment did not reduce subsequent episodes of post-partum depression.

Conclusions

Psychological intervention for post-partum depression improves maternal mood (EPDS) in the short term. However, this benefit is not superior to spontaneous remission in the long term.

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Copyright

Corresponding author

Professor Peter J. Cooper, Winnicott Research Unit, Department of Psychology University of Reading, Whiteknights, 3 Earley Gate, Reading RG6 6AL, UK

Footnotes

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See part 2, pp. 420–427, this issue

Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes

References

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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Appleby, L., Warner, R., Whitton, A., et al (1997) A controlled study of fluoxetine and cognitive–behavioural counselling in the treatment of postnatal depression. BMJ, 314, 932936.
Brugha, T. S., Wheatley, S., Taub, N. A., et al (2000) A pragmatic randomised trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors. Psychological Medicine, 30, 12731281.
Buist, A., Westley, D. & Hill, C. (1999) Antenatal prevention of postnatal depression. Archives of Women's Mental Health, 1, 167173.
Cooper, P. J., Campbell, E. A., Day, A., et al (1988) Non-psychotic psychiatric disorder after childbirth. A prospective study of prevalence, incidence, course and nature. British Journal of Psychiatry, 152, 799806.
Cox, J. L., Holden, J. M. & Sagovsky, R. (1987) Detection of postnatal depression. Development of the Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782786.
Cox, J. L., Murray, D. & Chapman, G. (1993) A controlled study of the onset, duration and prevalence of postnatal depression. British Journal of Psychiatry, 163, 2731.
Cramer, B., Robert-Tissot, C., Stern, D., et al (1990) Outcome evaluation in brief mother–infant psychotherapy: a preliminary report. Infant Mental Health Journal, 11, 278300.
Davies, H., Crombie, I. K. & Tavakoli, M. (1998) When can odds ratios mislead? BMJ, 316, 989991.
Diggle, P. J., Liang, K. Y. & Zeger, S. L. (1996) Analysis of Longitudinal Data. New York: Oxford University Press.
Elliott, S. A., Leverton, T. J., Sanjack, M., et al (2000) Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression. British Journal of Clinical Psychology, 39, 223241.
Everitt, B. S. & Pickles, A. (1999) Statistical Aspects of the Design and Analysis of Clinical Trials. River Edge, NJ: World Scientific Press.
Goldstein, H. (1995) Multilevel Statistical Models. London: Edward Arnold.
Hawton, K., Salkovskis, P., Kirk, J., et al (1989) Cognitive Behavioural Approaches to Adult Psychiatric Disorders. Oxford: Oxford University Press.
Henderson, A. G., Gregoire, A. J. P., Kumar, R., et al (1991) Treatment of severe postnatal depression with oestradiol skin patches. Lancet, 338, 816817.
Holden, J., Sagovsky, R. & Cox, J. L. (1989) Counselling in a general practice setting: a controlled study of health visitor intervention in the treatment of postnatal depression. BMJ, 298, 223226.
McDonough, S. (1993) Interaction guidance: understanding and treating early infant–caregiver relationship disorders. In Handbook of Infant Mental Health (ed. Zeanah, C.), pp. 414426. New York: Guilford Press.
Murray, L., Fiori-Cowley, A., Hooper, R., et al (1996) The impact of postnatal depression and associated adversity on early mother–infant interactions and later infant outcome. Child Development, 67, 25122526.
Murray, L., Cooper, P. J., Wilson, A., et al (2003) Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. 2. Impact on the mother-child relationship and child outcome. British Journal of Psychiatry, 182, 420427.
O'Hara, M. H. (1997) The nature of postpartum depressive disorders. In Postpartum Depression and Child Development (eds Murray, L. & Cooper, P. J.), pp. 331. New York: Guilford.
O'Hara, M. H. & Swain, A. M. (1996) Rates and risks of postpartum depression – a meta-analysis. International Review of Psychiatry, 8, 3754.
O'Hara, M. H., Stuart, S., Gorman, L. L., et al (2000) Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry, 57, 10391045.
Seeley, S., Murray, L. & Cooper, P. J. (1996) The outcome for mothers and babies of health visitor intervention. Health Visitor, 69, 135138.
Siegel, S. & Castellan, N. J. (1988) Nonparametric Statistics for the Behavioral Sciences. New York: McGraw-Hill.
Silove, D., Parker, G. & Manicavasagar, V. (1990) Perceptions of general and specific therapist behaviors. Journal of Nervous and Mental Disease, 178, 292299.
Spitzer, R. L., Williams, J. B. W., Gibbon, M., et al (1989) Structured Clinical Interview for DSM–III–R – Patient Edition (with Psychotic Screen). New York: Biometrics Research Department.
Stamp, G. E., Williams, A. S. & Crowther, C. A. (1995) Evaluation of antenatal and postnatal support to overcome postnatal depression: a randomised controlled trial. Birth, 22, 138143.
Stern, D. (1995) The Motherhood Constellation. New York: Basic Books.
Stuart, S. & O'Hara, M. W. (1995) Interpersonal psychotherapy for post-partum depression. Journal of Psychotherapy Practice and Research, 4, 1829.
Wickberg, B. & Hwang, C. (1996) Counselling of postnatal depression: a controlled study on a population based Swedish sample. Journal of Affective Disorders, 39, 209216.
Zhang, J. & Yu, K. F. (1998) What's the relative risk? A method for correcting odds ratio in cohort studies of common outcomes. Journal of the American Medical Association, 280, 16901691.

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Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: I. Impact on maternal mood

  • Peter J. Cooper (a1), Lynne Murray (a1), Anji Wilson (a2) and Helena Romaniuk (a1)
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