Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.a3064 (Published 16 January 2009) Cite this as: BMJ 2009;338:a3064All rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests