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RESEARCH: C-L Dennis, E Hodnett, L Kenton, J Weston, J Zupancic, D E Stewart, and A Kiss Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial BMJ 2009; 338: a3064 [Abstract] [Full text]

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Nothing New

joyce a venis   (26 January 2009)

Trial design undermines conclusions

Michael King, Irwin Nazareth   (31 January 2009)

There is more to it!

David R Musa   (1 February 2009)

Nothing New 26 January 2009
joyce a venis, psychiatric rn,ppd expert Princeton Psychiatric Centers 08540 Send response to journal: Re: Nothing New	Being a PPD survivor of over 40 years ago,directing an ante and postpartum support group for over 20 years,having written a book on this,having written a manual on support groups many years ago,having trained hundreds to be on call lists and to run groups,having started the first PMS group and first PPD group in NJ,having been an expert witness in a ppd case.....etc etc etc.....while I appreciate your research........this is nothing new.Thank you. In addition, a support group or person cannot prevent cancer, nor can it prevent a medical ppd. Competing interests: None declared
Trial design undermines conclusions 31 January 2009
Michael King, Professor of Primary Care Psychiatry UCL Medical School, Irwin Nazareth Send response to journal: Re: Trial design undermines conclusions	Prevention of post natal depression could potentially reduce harm to women, their children and their families. In this respect the trial by Dennis et al. is to be welcomed.. There are, however, problems with the trial design that undermine their conclusions. 1) Their study was not one of prevention since all women with Edinburgh Post Natal Depression Scale scores of >9 were included. Presumably a percentage already had clinical post natal depression but this is unknown as no diagnostic assessment was conducted at baseline; 2) Women with a diagnosis of postnatal depression at the 12 week follow-up point were referred on for treatment on ethical grounds; why was this omitted at baseline? Referral out of depressed women for help at baseline would have been preferable on ethical grounds and would have left a purer sample of women at risk for the prevention trial. 3) After 12 weeks there was a significant difference in symptoms on the Edinburgh Post Natal Depression Scale but no difference in diagnosed postnatal depression; 4) The authors explain away point 3 by suggesting that the diagnostic interviews (SCID) may not have been valid when conducted by nurses over the telephone; hardly reassuring; 5) Lower than expected rates of diagnosed postnatal depression at 12 weeks in both trial arms may simply be a factor of participation in the trial (Hawthorne effect); 6) Lastly, the telephone contacts with peers did not seem to be welcomed by the mothers. Although they were polite enough to express quite high levels of satisfaction overall, only 7% of them initiated a contact with their peers. This suggests they may not have regarded the intervention as particularly helpful. Competing interests: None declared
There is more to it! 1 February 2009
David R Musa, STR Psychiatry New Beginning .ECH. HA80AD Send response to journal: Re: There is more to it!	Many people assume only women experience PDD, indeed, this affects men also;the prevalence, it should be pointed out,is far lower than that for women. I do not generally see the strength of telephone screening in those who could be at high risk of developing PDD.Only 0.4% in the intervention group had face to face contact.As such, how was it known that the person at the end of the phone was who they claimed they were! I believe individual contact would have been more effective.As we know, EPDS is not diagnostic and so,personal contact would have been more accurate than the scores obtained.Visits could have dramatically reduced the rate of progression to PDD. PDD can be hereditary and those who suffer from PMS commonly suffer from PDD;some factors are also equally important like the social status of the women,their coping strategies [avoidance,venting,etc] and sexual orientations[as reflected on scores on the EPDS]. Of the 21470 attempted screens, 4400[20.5&] could not complete because of language barrier.This meant the level of education of the women had some influence and should have been considered as an inclusion criterion. It also seemed that the volunteer peers would have felt pressured over the activity logs. Aside from the above, and the other issues raised by earlier responders,I think this is a bold paper which is very relevant in these days of stresses on family and women and it would help to shed more light on ways to come to the aid of women at risk of developing PDD. References: 1-http://en.wikipedia.org/wiki/Postpartum_depression[main source] 2- Ross, Lori E. Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors. Women & Health. Vol 41 Issue 3: 113–128 3-Companion to psychiatric studies.E.Johnstone et al.7th edition pg. 751 Competing interests: None declared