Counselling and cognitive behavioural therapy reduce anxiety and depression in women with postnatal depression

摘要

Postpartum depression is a serious condition affecting approximately 13% of women from diverse cultures. While women who have suffered from postpartum depression are twice as likely to experience future episodes of depression over a five year period, infants and children are particularly vulnerable due to impaired maternal/infant interactions and negative perceptions of infant behaviour. Effective treatments are needed to prevent these poor outcomes. Antidepressant medication has been validated as an effective treatment for depression; however, mothers are often reluctant to take antidepres-sants due to concerns about breast milk transmission or potential side effects. Consequently, non-pharmacological interventions are required. While diverse treatment trials have been conducted, the study by Milgrom ef a/is unique because it provides a direct comparison between: (a) cognitive behavioural therapy and counselling; and (b) counselling that was offered individually or within a group. Despite the weaker randomisation procedure and the high attrition rate at the 12 month post-intervention assessment, the results of the trial suggest that counselling is just as effective as cognitive behavioural therapy in decreasing depressive symptoms. This is a clinically important finding, since counselling interventions can be delivered by a broad range of professionals compared with cognitive behavioural therapy. The researchers also reported that counselling provided individually was more effective than that provided in a group format, a finding consistent with a Cochrane systematic review that suggested individual-based interventions were more likely to prevent postpartum depression than those that were group-based. Although groups offer women an opportunity to interact with peers, they are often poorly attended by new mothers, especially those that are depressed. Research also suggests that mothers with lower incomes, who are less educated, or are members of ethnic minorities are more likely to withdraw from groups. Thus interventions targeted at individuals, using a structured approach to counselling, may be effective in treating postpartum depression and future research evaluating such interventions is warranted.