Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care
Open accessAbstract
Background: To test whether receiving care from a health visitor (HV) trained in identification and psychological intervention methods prevents depression 6–18 months postnatally in women who are not depressed 6 weeks postnatally. Method: The study was a prospective cluster trial, randomized by GP practice, with follow-up for 18 months in 101 primary care teams in the Trent area of England. The participants were women scoring <12 on the postal Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postnatally (1474 intervention and 767 control women). Intervention HVs (n=89, 63 clusters) were trained in identifying depressive symptoms using the EPDS and face-to-face clinical assessment and in providing psychologically orientated sessions based on cognitive behavioral or person-centered principles. The control group comprised HVs (n=49, 37 clusters) providing care as usual (CAU). The primary outcome measure was the proportion of women scoring ⩾12 on the EPDS at 6 months postnatally. Secondary outcomes were mean EPDS score, Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) score, State–Trait Anxiety Inventory (STAI), 12-item Short Form Health Survey (SF-12) and Parenting Stress Index Short Form (PSI-SF) scores at 6, 12 and 18 months. Results: After adjusting for individual-level covariates, living alone, previous postnatal depression (PND), the presence of one or more adverse life events and the 6-week EPDS score, the odds ratio (OR) for EPDS ⩾12 at 6 months was 0.71 [95% confidence interval (CI) 0.53–0.97, p=0.031] for the intervention group (IG) women compared with the control (CAU) group women. Two subgroups were formed by baseline severity: a ‘subthreshold’ subgroup with a 6-week EPDS score of 6–11 (n=999) and a ‘lowest severity’ subgroup with a 6-week EPDS score of 0–5 (n=1242). There was no difference in psychological effectiveness by subgroup (interaction term: z=−0.28, p=0.782). Conclusions: This study provides new evidence of a universal, enduring preventive effect for depression in women who screen negative for depression postnatally.
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In some contexts, medication is considered irrelevant as depression is not seen as a medical condition, and self-help preferred.
“In some contexts, medication is considered irrelevant as depression is not seen as a medical condition, and self-help preferred. 391”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [391]
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- Brugha TS Morrell CJ Slade P Dixon S 2009 Prevention of postnatal depression: cost-effectiveness of health visitor training; results from a cluster randomised controlled trial in primary care. Ninth Workshop on Costs and Assessment in Psychiatry. Quality and Outcomes in Mental Health Policy and Economics Journal of Mental Health Policy and Economics 12 (Suppl. 1), S8
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Self-citation
- Authors
- Brugha, T. S., Morrell, C. J., Slade, P., & Walters, S. J.
- Affiliations
- University of Leicester (GB)
- University of Nottingham (GB)
- University of Sheffield (GB)
- Corresponding author
- Brugha, T. S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2010-08-18
- Volume
- 41
- Issue
- 4
- Pages
- 739-748
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC3042795
- OpenAlex
- W2155559456
- Cited by
- 111
- References
- 40
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 3 · 2022: 7 · 2021: 9 · 2020: 2 · 2019: 8 · 2018: 8 · 2017: 7 · 2016: 9 · 2015: 15 · 2014: 9 · 2013: 13 · 2012: 5
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.cambridge.org/core/terms (unspecified)
- Locations
- Psychological Medicine (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (99/33/51)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- postpartum depression, universal prevention, health visitors, primary care, cognitive behavioral therapy, client-centered therapy, Edinburgh Postnatal Depression Scale, subthreshold depression, parental stress, anxiety, quality of life
- MeSH terms
- Adult, Community Health Nursing, England, Female, Follow-Up Studies, Humans, Life Change Events, Primary Health Care, Surveys and Questionnaires, Cognitive Behavioral Therapy, Cluster Analysis, Depression, Postpartum
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