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Psychological debriefing

BMJ 2001; 322 doi: (Published 14 April 2001) Cite this as: BMJ 2001;322:928

Providing good clinical care means listening to women's concerns

  1. Philip Boyce, professor of psychiatry (,
  2. John Condon, professor of psychiatry
  1. Department of Psychological Medicine, University of Sydney, Nepean Hospital, PO Box 63, Penrith, NSW 2750, Australia
  2. Flinders University of South Australia, Bedford Park, South Australia 5042, Australia
  3. Department of Child and Family Psychiatry, Royal United Hospital, Bath BA1 3NG
  4. Department of Management, University of St Andrews, St Katharine's West, St Andrews, Fife KY16 9AL
  5. Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, 251 Faraday Street, Carlton, Victoria 3053, Australia

    EDITOR—Small et al have shown the ineffectiveness of debriefing in reducing maternal depression after operative childbirth.1 Although we agree with the general findings of their study2 some methodological issues must be addressed, especially if their findings are interpreted to mean that women should not have the opportunity to talk about their delivery experiences in a therapeutic and supportive manner.

    The authors assert that the expected prevalence of postnatal depression is 24%3; this is considerably higher than the 13% reported in other studies.4 They assessed postnatal depression using the Edinburgh postnatal depression scale at six months postpartum (when its validity is uncertain), thereby excluding women who had had postnatal depression earlier but then recovered.

    Additionally, there is no indication in this study of the degree of stress associated with the delivery, and elective and emergency procedures were aggregated. In our clinical experience a forceps delivery is more traumatic than an elective caesarean section.

    Although a good response rate was achieved on the 1041 postal questionnaires, 662 eligible women did not participate (275 women declined to participate and participation was declined by the woman's doctor for 387 women), and 710 eligible women were discharged too soon to complete the study; therefore, less than half of all eligible participants actually entered the study. This calls into question the representativeness of the sample.

    Little detail is provided about the debriefing. Lee et al have highlighted the desirability of a debriefing after miscarriage being conducted by someone who could provide factual information and answer questions about the event.5 The research midwives would not have …

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