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Psychosocial and psychological interventions for prevention of postnatal depression: systematic review

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7507.15 (Published 30 June 2005) Cite this as: BMJ 2005;331:15

Rapid Response:

Prevention of Postnatal Depression or Distress

21 October 2005

Dear Editor,

In a recent article in the BMJ a systematic review of psychological
and psychosocial strategies to prevent postnatal depression was reported
(Dennis, 2005). One of the conclusions was that “this systematic review
shows that there is no clear evidence to recommend the implementation of
antenatal and postnatal classes…” (p. 18).

Unfortunately this review did not include a Randomised Controlled
Trial (RCT) by myself and colleagues (Matthey et al., 2004), cited in both
Medline and PsycINFO (this latter database was not included in the
systematic review), and published within the timeframe of the systematic
review. This study found a specific psychological strategy, introduced at
antenatal classes with some postnatal components, was effective at
reducing the level of depressive symptomatolgy for women previously
assessed as having low self-esteem.

There are many reasons why other psychosocial interventions may not
have been effective, whereas ours was. These include the obvious one that
the interventions in these other studies were inherently ineffective
(which may be due in some cases to the lack of involvement of mental
health professionals, as suggested by Lumley, 2005); or as often occurs
the lack of involvement in the intervention by the participants (often due
to low attendance at multi-session programs). In addition, we discussed
how most prevention programmes only analyse the data for main effects,
rather than interaction effects (that is, is the intervention more
effective for particular sub-groups of participants? – in our case, women
with low self-esteem).

It is therefore important that clinicians realise that, contrary to
the review’s conclusion about the lack of usefulness of antenatal classes,
one rigorous RCT, using a strategy package not previously tested, has
found significant benefits for women in the early postnatal period. These
benefits led Ogrodniczuk (2004), in an independent review of the study, to
conclude “The intervention appears to be feasible in any context that
involves parenthood classes. It seems to offer a cost efficient approach
to reducing maternal distress. The findings should change clinical
practice.” (p. 116).

I, and my colleagues, certainly hope that this last statement is the
case!

References

Dennis C-L. Psychosocial and psychological interventions for
prevention of postnatal depression: systematic review. BMJ 2005; 331:15-
18.

Lumley J. Attempts to prevent postnatal depression. BMJ 2005; 331: 5-
6.

Matthey S, Kavanagh D J, Howie P, Barnett B, Charles M. Prevention of
Postnatal Distress or Depression: an evaluation of an intervention at
Preparation for Parenthood classes. J Affect Disord 2004;79:113-126.

Ogrodniczuk, JS (commentator). Increasing a partner’s understanding
of motherhood significantly reduces postnatal distress and depression in
first time mothers with low self esteem. Evid Based Ment Health 2004; 7:
116.

Yours sincerely,

Stephen Matthey, Ph.D.
Research Director: ICAMHS ,
Sydney South West Area Health Service,
NSW Australia.

E: stephen.matthey@swsahs.nsw.gov.au

Competing interests:
None declared

Competing interests: No competing interests

21 October 2005
Stephen Matthey
Research Director, Infant, Child & Adolescent Mental Health Service
Sydney South West Area Health Service, ICAMHS, Liverpool 2170. NSW. Australia.