Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling
Open accessAbstract
BACKGROUND: Postnatal depression (PND) is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND) following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs) alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT), delivered by postnatal nurses or psychologists. METHODS: This was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres) and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups. RESULTS: Mean scores on the Beck Depression Inventory (BDI-II) at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028). However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%), and subsequent treatment uptake (40%) were low. CONCLUSIONS: Data from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research.
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Jeannette Milgrom et al. demonstrated that training family physicians to treat PPD significantly improved symptoms.
“Jeannette Milgrom et al. demonstrated that training family physicians to treat PPD significantly improved symptoms [36].”
From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [36]
The Methods say participating GPs received training, and the Discussion reports significant reductions in depressive symptoms in all treatment groups. But the Discussion also says there was no untrained or wait-listed control group, so the trial cannot establish that GP training itself caused the improvement. (LLM, conf=0.88)
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“Specific psychological support was also provided through empathic listening, encouragement to express negative feelings, recognition of maternal ambivalence, and normalization of destabilizing emotional experiences (31, 32).”
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- Authors
- Milgrom, J., Holt, C. J., Gemmill, A. W., Ericksen, J., Leigh, B., Buist, A., & Schembri, C.
- Affiliations
- The University of Melbourne (AU)
- Heidelberg Repatriation Hospital (AU)
- Corresponding author
- Milgrom, Jeannette
- Venue
- BMC Psychiatry
- Published
- 2011-05-27
- Volume
- 11
- Issue
- 1
- Pages
- 95-95
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3121669
- OpenAlex
- W2017292177
- Cited by
- 82
- References
- 3
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 25 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 4 · 2016: 3 · 2015: 7 · 2014: 4 · 2013: 6 · 2012: 3
- FWCI
- 3.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Royal Australian and New Zealand College of Psychiatrists
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- postpartum depression, general practitioner management, cognitive behavioral therapy, Edinburgh Postnatal Depression Scale, primary care, help-seeking, treatment uptake, maternal and child health center
- MeSH terms
- Adult, Counseling, Female, Humans, Patient Compliance, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Patient Satisfaction, Depression, Postpartum, Physicians, Primary Care
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