Abstract
Background: Post-natal Depression is a major public health problem with an increasing literature suggesting chronicity, adverse infant outcome and marital breakdown as significant consequences of this disorder. There is a remarkable paucity of randomised controlled treatment trials in this area. This study utilises the existing treatment network involved with this population in a liaison with primary care initiative, using ECNs as therapists under psychiatric supervision.
Objectives: This project has two objectives, (1) to establish whether ECNs can be trained in a modified CBT for PND, (2) to compare the outcome of women treated with this therapy with “ideal standard care” using non-specific counselling by ECNs with no additional training.
Methods: Five ECNs were trained in CBT and supervised weekly by a senior psychiatry registrar who had developed a CBT work-book as the basis of the therapy. All ECNs in Eastern Sydney screened women postnatally using the Edinburgh PND Scale. Those with scores over 12 were assessed in a one-hour home-based interview using DSM-IV major and minor depression criteria, and undertaking a variety of baseline scales. Women were then randomised into “ideal standard care” or CBT groups for six weekly sessions. Two stages of follow-up were undertaken; a registrar interview at six weeks and a postal follow-up at six months.
Results: Training was evaluated by questionnaires and assessment of therapy tapes. These assessments indicated that ECNs were able to be trained to deliver basic CBT. The initial follow-up data showed a trend towards greater efficacy of CBT, as the CBT group was more unwell at baseline and equally recovered at follow-up (on EPNDS) and the “usual care” had worse MADRAS scores at follow-up indicating that they were more symptomatic. The six-month follow-up data will be available in April. Of note was the extremely high recovery rate of both groups at the six-week follow-up with 70–80% recovered on EPDS and MADRAS scores. The possible interpretations of these results, referencing interesting data from recent psychotherapy research will be discussed, as will future directions for research in this important area.