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For the control group the high rate of such problems
did not reduce from six weeks to four months postpartum;
whereas for the group receiving the health visitor
intervention the rate of these difficulties was halved
over this period. The rate of relationship problems
at four months was significantly lower in the intervention
than in the control group (X2
= 13.3, df=1, p<0.001).
This difference was not simply due to the greater
improvement in maternal mood arising from the intervention:
when the level of the mother’s depressive symptoms
(as assessed by the EPDS score) was taken into account
(using logistic regression), the difference between
the proportions of women in the two groups reporting
relationship problems at four months remained highly
significant (X2 = 10.7, df = 1,
p<0.001).
Health visitor experiences of the
study.
An attempt was made to assess health visitors’ perceptions
of the experience of screening and intervention. A
questionnaire was sent to all the health visitors
who participated (n=46) and 32 were anonymously returned.
Overall, the training in both the detection and management
of postnatal depression was very well received. The
EPDS was felt to be a helpful tool which the health
visitors saw as assisting them in detecting women
with depression whom they would otherwise miss. It
was also perceived as a means of facilitating discussion
of maternal feelings, often with mothers' partners
and families as well as with health visitors. There
were felt to be improvements in the health visitors’
relationships with their clients. The training in
therapy skills, both counselling and cognitive behavioural
techniques, was also much appreciated - many health
visitors finding increased confidence in other areas
of their work. However, reservations were expressed
that the systematic assessment and the sometimes difficult
content of the intervention itself could generate
stress and a workload additional to normal practice.
Conclusions
The results of this series of studies show that postnatally
depressed women represent a group of mothers who are
at risk for experiencing significant difficulties
in their relationship with, and care of, their infants.
In the course of routine primary care a substantial
proportion of those experiencing depression go undetected,
and, moreover, such women receive no additional input
from the health care services set up to serve their
needs. Nevertheless, with the provision of modest
resources, health visitors can be trained in the detection
and management of postnatal depression and associated
difficulties in the mother-infant relationship, and
can deliver an intervention that is both effective
and highly acceptable to depressed mothers.
We have reason to believe that these benefits of
intervention may be sustained: a follow up study of
similarly treated postnatally depressed mothers in
Cambridge showed that at eighteen months significantly
fewer child behaviour problems were reported by mothers
receiving brief interventions compared to those receiving
routine care (Cooper and Murray, 1995).
December 1994
First published: Health Visitor 1996; 69,4, 135-238
Sheelah Seeley Research Health Visitor
Lynne Murray MRC Senior Fellow
Peter J Cooper Professor of Psychology*
University of Cambridge, Cambridge
CB1 2ES
Winnicott Research Unit Department
of Psychology*
Department of Psychiatry University of Reading,
3 Earley Gate, Whiteknights, Reading
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