- Mother's Mood
- Mother-Infant Relationship
- Child Development
Two papers published in the May issue of the British Journal
of Psychiatry show that brief home-based psychological therapies
for postnatal depression improve the mother's mood, the
mother-infant relationship and child behaviour problems in the
short term.
However, more prolonged treatment may be needed if these
improvements are to last.
Postnatal depression occurs after about 10% of deliveries.
Although it tends to get better spontaneously after 4-6 months, it
causes considerable distress and disruption to the women and their
families, and affects the quality of the early mother-child
relationship as well as the emotional development of the
child.
The aim of this study was to evaluate the long-term effect of
three psychological treatments on these consequences of postnatal
depression.
193 women with postnatal depression were randomly assigned to
one of four conditions: non-directive counselling,
cognitive-behavioural therapy (CBT), psychodynamic therapy or
routine primary care (the control group). They and their children
were assessed immediately after the treatment phase at 4.5 months,
and at nine, 18 and 60 months after birth.
The study therapists included health visitors who received
training in CBT and counselling treatments, as well as specialist
professional therapists representing each of the three treatment
approaches.
Therapy was conducted weekly in the women's own homes from 8-
18 weeks after birth. Eight weeks is the time when postnatal
depression is likely to be detected by the primary care team.
Effect of treatment on mother's mood:
At 4.5 months symptoms of depression in all three treatment groups
had improved significantly compared with the control group.
The benefit of treatment was no longer apparent nine months
after birth, because the spontaneous remission rate brought the
women in the control group to the same point as those in the three
treatment groups.
Treatment did not reduce subsequent episodes of postnatal
depression.
Effect on mother-child relationship and child outcome:
At 4.5 months all three treatments had a significant benefit on
maternal reports of early difficulties in relationships with the
infants. Counselling gave better infant emotional and behaviour
ratings at 18 months, and more sensitive early mother-infant
interactions, for women experiencing high levels of social
adversity.
The treatments had no significant impact on maternal
management of early infant behaviour problems, security of
infant-mother attachment, infant cognitive development or any child
outcome at five years.
The authors comment that the fact that the three treatments
provided only limited, short-term benefits suggests that underlying
maternal vulnerabilities persisted. In order to prevent longer-term
difficulties, more prolonged interventions may be needed.
There was no evidence that specialist therapists were more
effective than non-specialist health visitors. Compared with
routine care, counselling was the most effective treatment for
mother-child relationships and child outcome, and health visitors
are well-placed to deliver such support.
Health visitors' training and practice should be extended to
encompass the detection and management of mothers with postnatal
depression
For further information, please contact Liz Fox or Deborah
Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127