Major depression is common following childbirth and it is estimated that up to 50 per cent of cases remain undetected while about 30 per cent of those identified fail to keep clinic appointments. Effective means of identifying “at-risk” women are available but may not be used to their full advantage.

Dr Henri Chabrol and colleagues from Toulouse-Le-Mirail University evaluated the usefulness of a structured program of depression detection and prevention in women admitted to three obstetric clinics in the Toulouse and Narbonne regions between December 1999 and March 2000.

The team identified 859 eligible women and asked these subjects to complete a brief self-report scale – the Edinburgh Post-natal Depression Scale (EPDS) – during their stay at the clinics.

Mothers deemed to be at risk of post-natal depression (an EPDS score of 9 or greater) were randomly assigned to a prevention/treatment group or a control group.

The intervention group received an hour-long prevention session between the second and fifth day after giving birth, which comprised an educational component explaining the realities of parenthood, a supportive component featuring empathic listening and a cognitive-behavioral component to develop problem-solving strategies.

A second EPDS was given to both the intervention and the control group during the period four to six weeks post-partum. Mothers with probable depression (EPDS score of 11 or more) were assessed using the Hamilton Depression Rating Scale and the Beck Depression Inventory, and continued in the intervention or control group.

Depressed mothers in the intervention group undertook a cognitive-behavior program comprising five to eight weekly home visits, each lasting one hour. At the end of this period, both groups were re-screened for depression.

The prevention intervention resulted in a significant reduction in depressive symptoms and in the frequency of probable depression four to six weeks post-partum.

Drop-out rates were high in the first part of the study (25 per cent), but all of the women who agreed to the home intervention completed the treatment.

Overall the intervention was well accepted.

“Home visits are a convenient way of treatment for post-partum depressed women who are often tired and overwhelmed,” explained the study authors.

“This prevention and treatment program might also have high applicability as all mothers could be routinely contacted while still in the maternity hospital or clinic,” they added.

They suggest that a combination of early prevention and treatment might be a solution to the low detection and compliance to treatment rates typically found in post-partum depression.

Reference: Chabrol et al, Psychological Medicine 2002;32:1039-1047

(c) HMG Worldwide Ltd 2002
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