Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: a randomised controlled trial
Open accessAbstract
BACKGROUND: Maternal postnatal depression occurs following 10-15% of births and is associated with a range of negative child outcomes. Risks to children are particularly increased when postnatal depression is persistent. We aimed to examine whether a parenting video-feedback therapy (VFT) intervention versus a control treatment of progressive muscle relaxation (PMR), both added to cognitive behavioural therapy (CBT) for persistent postnatal depression, would lead to improved child outcomes at age 2 years. METHODS: In this two-arm, parallel-design, individually randomised controlled trial, we recruited a community sample of women aged 18 years or older living within 50 miles of Oxford, UK, between 4·5 and 9·0 months post partum. All participants met diagnostic criteria for current major depressive disorder that had persisted for at least 3 months and had infants at 35 or more weeks of gestation, with a birthweight of 2000 g or greater, and without serious neonatal complications. Through a centralised service, women were randomly assigned by use of a minimisation algorithm, to receive either VFT or PMR, balanced for child sex, temperament, age, socioeconomic status, and severity of depression. Both groups also received CBT for depression. Primary outcomes were child cognitive development, language development, behaviour problems, and attachment security at age 2 years. There were 11 home-based treatment sessions before child age 1 year, followed by two booster sessions in the second year. Assessors were masked to treatment group allocation. All analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN registry, number ISRCTN07336477. FINDINGS: Between March 18, 2011, and Dec 9, 2013, we randomly assigned 144 women, 72 to each group. Primary outcome data were available for 62-64 (86-89%) VFT and 67-68 (93-94%) PMR participants. There were no group differences in child outcome (cognitive development, adjusted difference -1·01 [95% CI -5·11 to 3·09], p=0·63; language development, 1·33 [-4·16 to 6·82], p=0·63; behaviour problems, -1·77 [-4·39 to 0·85], p=0·19; attachment security, 0·02 [-0·06 to 0·10], p=0·58), with both groups achieving scores similar to non-clinical norms on all outcomes. There were six serious adverse events: five in the VFT group (in two participants) and one in the PMR group. None was treatment-related. INTERPRETATION: The effect of persistent postnatal depression on children is a major public health issue. For both treatment groups there was sustained remission from depression, and child development outcomes were in the normal range. The precise mechanisms accounting for the observed positive child outcomes cannot be ascertained from this study. FUNDING: Wellcome Trust.
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Postpartum depression is associated with increased risk for impairments in the mother's perceived bonding and attachment to the infant, both during the antepartum and postpartum period.
“postpartum depression is associated with increased risk for impairments in the mother’s perceived bonding and attachment to the infant, both during the antepartum and postpartum period;”
From Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol (2019) · cites this paper as [12]
The Introduction (page not provided) says postnatal depression can be associated with insecure attachment and describes difficulties in the mother–infant relationship. It does not establish impairment in mothers’ perceived bonding or attachment, or an association during the antepartum period. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the postpartum period, postpartum depression is related to impairments in maternal responsiveness or sensitivity (parenting).
“in the postpartum period, this is related to impairments in maternal responsiveness or sensitivity (hereafter referred to as parenting).12”
Prospectively, peripartum depression is related to impairments in the infant's cognitive, social and emotional functioning.
“Prospectively, PPD is related to impairments in the infant’s cognitive, social and emotional functioning.12 13”
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- Authors
- Stein, A., Netsi, E., Lawrence, P. J., Granger, C., Kempton, C., Craske, M. G., Nickless, A., Mollison, J., Stewart, D. A., Rapa, E., West, V., Scerif, G., Cooper, P. J., & Murray, L.
- Affiliations
- University of the Witwatersrand (ZA)
- University of Oxford (GB)
- University of California, Los Angeles (US)
- University of Cape Town (ZA)
- Corresponding author
- Stein, Alan
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 5
- Issue
- 2
- Pages
- 134-144
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2784525915
- Cited by
- 148
- References
- 48
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 26 · 2023: 20 · 2022: 22 · 2021: 21 · 2020: 21 · 2019: 14 · 2018: 7
- FWCI
- 15.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by)
- ePrints Soton (University of Southampton) (acceptedVersion)
- CentAUR (University of Reading) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- Funders
- John D. and Catherine T. MacArthur Foundation
- Wellcome Trust (090139)
- Economic and Social Research Council (ES/P009794/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- postpartum depression, progressive muscle relaxation, cognitive behavioral therapy, child cognitive development, child language acquisition, child behavior problems, attachment security, home-based intervention, postpartum mental health, booster sessions, community-based treatment, parenting support
- MeSH terms
- Adult, Child Behavior, Child Development, Child, Preschool, Depressive Disorder, Major, Major Depressive Disorder, Feedback, Female, Humans, Language Development, Male, Videotape Recording, Cognitive Behavioral Therapy, Parenting, Depression, Postpartum
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