Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: A randomised controlled trial

Austin, M.-P.; Frilingos, M.; Lumley, J.; Hadzi-Pavlovic, D.; Roncolato, W.; Acland, S.; Saint, K.; Segal, N.; Parker, G.

doi:10.1016/j.jad.2007.04.001

« Previous Next »Journal of Affective Disorders
Volume 105, Issue 1 , Pages 35-44, January 2008

Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: A randomised controlled trial

M.-P. Austin
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
- Corresponding author. Department of Liaison Psychiatry, Prince of Wales Hospital, High St, Randwick N.S.W. 2031. Tel.: +61 2 9382 2846; fax: +61 2 9382 2177.
M. Frilingos
- Royal Hospital for Women, Sydney, Australia
J. Lumley
- Mother and Child Health Research, La Trobe University, Melbourne, Australia
D. Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
W. Roncolato
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
S. Acland
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
K. Saint
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
N. Segal
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
G. Parker
- School of Psychiatry, University of New South Wales; and Black Dog Institute, Prince of Wales Hospital, Sydney, Australia

Received 3 September 2006; received in revised form 2 April 2007; accepted 2 April 2007.

Abstract

Background

The majority of randomised controlled trials examining the effectiveness of antenatal group interventions at preventing postnatal depression in “at risk” women have used a “psychoeducational” intervention. The aim of the present study is to evaluate the effectiveness of an antenatal cognitive behavioural group intervention in a primary care setting for pregnant women identified with mild to moderate symptoms in pregnancy and/or at risk of developing depression or anxiety in the perinatal period.

Method

Subjects were randomised to a CBT group intervention or control condition (information booklet) and administered the EPDS and STAI at pre (Time 1) and post intervention (Time 2), and at 2 months (Time 3) and 4 months postpartum (Time 4). MINIs were administered at Times 1, 3 and 4.

Results

Of the 774 women approached, 277 accepted and were suitable; thus 191 were randomised to the CBT intervention and 86 to the control condition. The subsequent 52% drop-out left 89 women “completing” the CBT groups and 43 in the control group; these two groups were well matched on demographic variables. Intention to treat analyses revealed relatively low mean baseline EPDS scores (means 6.88 -8.16) with no reduction in EPDS scores in either group from Time 1 to Time 4. MINI depression criteria were fulfilled by 19% of all participants at Time 1 but there was no reduction in depression in either group; in contrast those with MINI anxiety diagnoses reduced from 28% in late pregnancy to 16% at four months postpartum in the CBT group with similar reductions in the control group. Analyses on the 132 “completers” showed significant symptomatic improvement over time for both the CBT group and control condition. Depression scores in the most symptomatic women (EPDS>12; N=19) decreased steadily by over 50% over the total time course but there were no differences in improvement between the CBT and control groups.

Limitations

A number of methodological factors may have obscured our results including a tendency to natural remission in mildly symptomatic subjects and the possibility that our control condition was therapeutic in itself.

Conclusion

While a modest reduction in depression scores was noted in study “completers”, both the CBT group intervention control condition were equally beneficial. The reasons for this finding include the low symptom level at baseline; the potential effectiveness of the control condition; and the brevity of the intervention.

Keywords: Antenatal, Postnatal, Depression, Anxiety, Prevention, Pregnancy, Cognitive behaviour therapy