A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression.
A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression.
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DOI：
10.1186/1471-244x-13-33
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发表时间：
2013-01-22
期刊：
影响因子：
4.4
通讯作者：
Evans J
中科院分区：
文献类型：
--
作者：
Burns A;O'Mahen H;Baxter H;Bennert K;Wiles N;Ramchandani P;Turner K;Sharp D;Thorn J;Noble S;Evans J
很少有试验评估心理治疗在改善妊娠结束时抑郁症的有效性。这是第一项针对个体认知行为疗法（CBT）的随机对照试验（RCT），旨在治疗妊娠末期抑郁症。我们的目的是评估在怀孕期间提供修改为产前抑郁症的CBT干预的可行性。英国北布里斯托的孕妇在怀孕8-18周之间通过与助产士的常规接触招募，并随机接受多达12次的个人CBT，除了常规护理或继续常规护理。如果女性在助产士常规使用的3个问题抑郁筛查中筛查为阳性，并且符合使用临床访谈计划修订版（CIS-R）评估的ICD-10抑郁标准，则有资格进行随机分组。两名CBT治疗师进行了干预。在随机化后15周和33周进行随访，使用包括CIS-R在内的指标评估心理健康。在接受试验评估的50名妇女中，36名符合ICD-10抑郁症标准，并被随机分配：18名接受干预，18名接受常规护理。在18名被分配接受干预的妇女中，有13名（72%）在妊娠结束前完成了9次或更多次CBT。随机化后15周和33周的随访率在接受干预的组中更高（随机化后15周为89% vs. 72%，随机化后33周为89% vs. 61%）。在随机化后15周（妊娠结束），干预组中康复（即不再符合ICD-10抑郁症标准）的女性（11/16; 68.7%）多于仅接受常规护理的女性（5/13; 38.5%）。这项试点试验表明，进行一项大型RCT来评估CBT在妊娠结束前治疗产前抑郁症的有效性是可行的。干预措施可以在产前进行，有一些证据表明它可能是有效的。ISRCTN44902048
Few trials have evaluated the effectiveness of psychological treatment in improving depression by the end of pregnancy. This is the first pilot randomised controlled trial (RCT) of individual cognitive behavioural therapy (CBT) looking at treating depression by the end of pregnancy. Our aim was to assess the feasibility of delivering a CBT intervention modified for antenatal depression during pregnancy. Women in North Bristol, UK between 8–18 weeks pregnant were recruited through routine contact with midwives and randomised to receive up to 12 sessions of individual CBT in addition to usual care or to continue with usual care only. Women were eligible for randomisation if they screened positive on a 3-question depression screen used routinely by midwives and met ICD-10 criteria for depression assessed using the clinical interview schedule – revised version (CIS-R). Two CBT therapists delivered the intervention. Follow-up was at 15 and 33 weeks post-randomisation when assessments of mental health were made using measures which included the CIS-R. Of the 50 women assessed for the trial, 36 met ICD-10 depression criteria and were randomised: 18 to the intervention and 18 to usual care. Thirteen of the 18 (72%) women who were allocated to receive the intervention completed 9 or more sessions of CBT before the end of pregnancy. Follow-up rates at 15 and 33 weeks post-randomisation were higher in the group who received the intervention (89% vs. 72% at 15 weeks and 89% vs. 61% at 33 weeks post-randomisation). At 15 weeks post-randomisation (the end of pregnancy), there were more women in the intervention group (11/16; 68.7%) who recovered (i.e. no longer met ICD-10 criteria for depression), than those receiving only usual care (5/13; 38.5%). This pilot trial shows the feasibility of conducting a large RCT to assess the effectiveness of CBT for treating antenatal depression before the end of pregnancy. The intervention could be delivered during the antenatal period and there was some evidence to suggest that it could be effective. ISRCTN44902048