| |
|
| |
|
| |
|
|
|
Method
i) Maternal experience of infant care
A consecutive series of women who had delivered at
the local maternity hospital in Cambridge was screened
at six weeks postpartum using the Edinburgh Postnatal
Depression Scale or EPDS (Cox et al, 1987). Those
whose scores indicated possible depression were subsequently
interviewed using the mood section of the Structured
Clinical Interview for DSM diagnoses (Spitzer, 1989).
A sample of 40 women was thereby identified satisfying
DSM III-R (APA, 1982) criteria for major depressive
disorder. A random sample of 40 non-depressed women
from the same postnatal population was selected as
controls. The experience of infant care was assessed
in all 80 women, at eight weeks postpartum, using
a structured interview specifically designed for this
purpose. All interviews, carried out in the women’s
own homes, covered practical aspects of infant care,
such as sleeping and feeding, as well as aspects of
the mother’s experience of her relationship with her
infant.
|
| Table 1 contains a summary of the main
areas of difference between the two groups. It is apparent
that, compared to the non-depressed group, the depressed
mothers were significantly more likely to report a range
of difficulties with their infant. These included disturbances
in sleeping, excessive crying, feeding and digestion
problems, and difficulties combining managing the infant’s
demands for attention while trying to get on with other
activities. |
 |
|
ii). Health visitor awareness
of postnatal depression
In order to examine health visitors’ awareness of
postnatal depression and their response to it, an
examination was made of the case notes of postnatally
depressed women from the same sample pool as that
described above who were resident in Cambridge Health
Authority area (numbering 25), together with well
controls on the same health visitor registers.
This information was used to determine, for the first
six months postpartum, the level of contact with the
health visitor, (i.e. the number of clinic and home
contacts), and any particular difficulties which had
been recorded.
The health visitors responsible for these 50 mothers
were also contacted and interviewed. In particular,
they were asked to give their own assessment of the
early months of :
· the degree
to which the infant had been difficult to manage
· the mothers'
difficulties experienced with the infant and
· the mother’s
mood.
|
|
The results are summarised in Table
2 opposite. They show that:
- the babies of depressed mothers are rated by health
visitors as significantly more "difficult"
than those of non-depressed mothers
- depressed mothers are rated by health visitors
as having experienced significantly more difficulties
coping with their babies than non-depressed mothers
|
 |
- depressed mothers did not either attend clinic
more frequently or receive more home visits than
well mothers. If anything they made less use of
clinics than did well women.
|
 |
The lack of additional support given overall to the
group of mothers who were depressed appears to have
come about because maternal depression was not detected
in a substantial proportion of cases (Table 3). Of
the 25 depressed women in the current sample 11 (40%)
were not seen to be depressed by their health visitors.
|
|
In fact, the health visitors were more accurate in
identifying well women. Of the 25 non-depressed women,
17 were correctly identified and received the least
visiting (average number of home visits - 3.6), but
the 8 well women incorrectly identified as depressed
received the most visits (5.7).
iii) The intervention study
There were 2 components to the study:
· health visitors
were trained to detect and treat postnatal depression;
and
· Assessments of
maternal mood (EPDS) and perceptions of the extent
of difficulty experienced over a range of common
problems (problem sheet) were made both at the time
of diagnosis and after supportive treatment.
|
|
|
|
|
