Wednesday, 1 December 2010

New reports and findings on postnatal depression

Thank you to The Child and Maternal Health Observatory  for these postings:-

Treatments for postnatal depression assessed
News release from NETSCC, HTA    06 October 2010
Giving postnatal women antidepressants early in the course of the illness is likely to result in the greatest improvement in symptoms. This is according to new research funded by the National Institute for Health Research, Health Technology Assessment (NIHR HTA) programme.

Postnatal depression is a substantial public health problem affecting around 10 per cent of new mothers. It can lead to long-term serious consequences for mother, baby, family, friends and colleagues. Despite its frequency and potential long-term consequences, only about 50 per cent of cases of postnatal depression are detected by health professionals. However, like other forms of depression, if detected, postnatal depression is easily treatable.

The team, led by Professor Deborah Sharp from the University of Bristol, compared the effectiveness and cost-effectiveness of antidepressant drug therapy with a community-based psychosocial intervention. A total of 254 women were recruited from 77 general practices in England to receive either an antidepressant prescribed by their GP or counselling (listening visits) from a specially trained research health visitor (HV).

The results show that in the population studied where the prevalence of postnatal depression was just under 10 per cent, antidepressants were significantly superior to general supportive care at four weeks. There was a lack of evidence for a significant difference between antidepressant therapy and listening visits at 18 weeks as the trial design allowed women to switch groups, or add the alternative intervention at any time after four weeks.

“Although many women - at least initially, revealed a preference for listening visits, it would appear that starting women on antidepressants early in the course of illness is likely to result in the greatest improvement in symptoms”, says Professor Sharp. “There is an urgent need for GPs and HVs to agree the care pathway for women who suffer from postnatal depression, not only for the benefit of the mother, but also the child”.

Depression, like many illnesses, can be treated while breastfeeding without harming the baby. Breastfeeding women should speak to their midwife, health visitor or GP to find a suitable treatment. To view full details about this project visit: 

I FULLY agree with Professor Sharp's statement -  “There is an urgent need for GPs and HVs to agree the care pathway for women who suffer from postnatal depression, not only for the benefit of the mother, but also the child”.

Also look at

Children's Services Mapping: Perinatal mental health and infant mental health services
With recognition of the need to improve perinatal mental health services, questions were added to the 2009/10 Children’s Services Mapping (CSM) exercise to establish a baseline of service provision in England. The findings from the this mapping exercise are available - the data tables, full report and a national summary report can be viewed or downloaded from the CSM website.

Clinical Report—Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice

Every year, more than 400 000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development.

Long-term effects of a home-visiting intervention for depressed mothers and their infants Background: Whereas preventive interventions for depressed mothers and their infants have yielded positive short-term outcomes, few studies have examined their long-term effectiveness. The present follow-up of a randomised controlled trial (RCT) is one of the first to examine the longer-term effects of an intervention for mothers with postpartum depression and their infants at school-age. In early infancy, the intervention was found effective in improving mother–infant interaction and the child’s attachment to its mother.

Helping children sleep
Sleep problems in children are very common and affect both the child and parents. This review summarises current non-pharmacological practices and intervention options to aid healthy children sleep. Identifying and managing sleep problems in childhood may improve health, including emotional well-being, in adolescence and adulthood.

Incidence of maternal and paternal depression in primary care
: a cohort study using a primary care database
The aim of the study was to examine incidence, trends, and correlates of parental depression in primary care from 0 to 12 years of child age. They found that overall incidences of depression from the birth of the child up to age 12 years were 7.53 per 100 person-years for mothers and 2.69 per 100 person-years for fathers.

The role of midwives in facilitating recovery in postpartum psychosis

Postpartum psychosis can result in an increased risk of suicide and infanticide and the symptoms can be frightening for the women who are affected as well as for their families and obstetric care providers. The women are often thrust into a mental health system that does not capitalize on the close relational bond that forms between midwives and those they care for over the course of prenatal care. The purpose of this article is to propose using the Recovery Advisory Group Model of mental illness as a theoretical framework for care of women with postpartum psychosis, to assist midwives in recognizing symptoms, define the role of the midwife in treatment, and learn the importance of becoming part of the psychiatric mental health care team in order to facilitate optimum recovery.

Elaine Hanzak 

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