The world's first ever analysis of data from a full-scale clinical trial in adults shows that training health visitors to assess and psychologically support mothers after childbirth can prevent the development of depression over the following year.
But the substantial reduction in the number of NHS health visitors was identified by researchers as a key issue for the health and wellbeing of mums.
The prevention study was led at the University of Leicester by Professor Terry Brugha, with researchers from the universities of Nottingham and Sheffield. It is being published in the Cambridge University Press journal Psychological Medicine.
While small-scale studies have been carried out into the prevention of depression among adults, this peer-refereed scientific report is the first sufficiently large-scale, randomized trial to clearly show a statistically significant reduction in future cases of depression in women living in the community who were not depressed when they joined the study.
Lead author, Professor Brugha, of the University of Leicester Clinical Division of Psychiatry, Department of Health Sciences, said: "Up until now, it was thought that depression could only be treated when it is picked up by a GP or health visitor. But this study shows that women are less likely to become depressed in the year after childbirth if they are attended by an NHS health visitor who has undergone additional training in specific mental health assessment and in psychological approaches based on either cognitive behavioural or listening techniques.
"Women receiving usual care were significantly more likely to develop depression six months after childbirth.
"However, when the research team set out to repeat and develop further this research they were unable to make sufficient progress because in most parts of England there has been a substantial reduction in the number of health visitors funded by the NHS.
"Mothers were fortunate if they receive just one home visit from a health visitor. Health visitors were unable to take time off to undergo the extra training in assessment of depression and psychologically support approaches. Therefore, the research team at the University of Leicester are now considering undertaking further research on prevention of postnatal depression in other parts of the world."
Other key findings were:
Depression is thought to affect about one in 10 women following childbirth, depending on the definition and method used to assess depression. The consequences for the child and family are even more profound and concerning than when depression affects adults at other times.
The World Health Organization has predicted that depression will be a leading cause of disability due to ill health by the year 2020. Although depression can be treated effectively with medication and psychological approaches, there is no evidence that rates of depression have fallen since these treatments became available. It is also often the case that once treatment is stopped the condition can relapse.
The prevention study involved analysing data already collected as part of the PoNDER clinical trial originally designed to test the effectiveness of health visitors identifying and managing postnatal depression following childbirth.
Dr Jane Morrell, now at the University of Nottingham, was Principal Investigator for the PoNDER trial with a team of researchers at the Universities of Sheffield (Jane Morrell, Pauline Slade, Stephen Walters), Leicester and Leeds, with funding from the NIHR Health Technology Assessment programme, London.
While the PoNDER treatment trial was published in the BMJ in 2009, the research into prevention of depression required additional collaborative analysis by the authors of this new scientific paper which is now published separately in the Cambridge University Press journal Psychological Medicine.
Your comments (terms and conditions apply):
"I am a health visitor and I think our role is significantly undervalued. I have supported many new mothers in early depression hopefully with long-term positive results. I have been very lucky in the fact that although I am a generic health visitor our flying start manager (who have more funds)
has invited and supported us in extra training with regards to postnatal depression. I also undertook my dissertation on postnatal depression. We run a new mums group locally where mums can meet up and support each other hopefully supporting prevention of depression. I am sad that further research can not be done due to lack of health visitors!!" - Julie Wyer, S Wales
"As a newly retired HV the research findings are no surprise to me. The HV role has been allowed to 'die on the vine' and it is only now that it being recognised how important the role of the HV and support visits are. I went to a lecture some years ago and research then stated that the children of depressed mothers were having learning difficulties at school years later" - Anne Evans, West Sussex
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