Brief antenatal cognitive behaviour therapy group intervention for the-prevention of postnatal depression and anxiety: A randomised controlled trial
Brief antenatal cognitive behaviour therapy group intervention for the-prevention of postnatal depression and anxiety: A randomised controlled trial
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DOI：
10.1016/j.jad.2007.04.001
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发表时间：
2008-01-01
影响因子：
6.6
通讯作者：
Parker, G.
中科院分区：
文献类型：
--
作者：
Austin, M. -P.;Frilingos, M.;Parker, G.
背景资料：大多数随机对照试验检查产前群体干预措施在预防“高危”妇女产后抑郁症方面的有效性，都使用了“心理教育”干预措施。本研究的目的是评估在初级保健环境中对妊娠期有轻度至中度症状和/或围产期有抑郁或焦虑风险的孕妇进行产前认知行为小组干预的有效性。方法：受试者被随机分配到CBT组干预或对照组（信息手册），并在干预前（时间1）和干预后（时间2），以及产后2个月（时间3）和4个月（时间4）进行EPDS和STAI。在第1、3和4次给予MINI。结果：在774名接近的妇女中，277名接受并适合;因此，191名被随机分配到CBT干预组，86名被随机分配到对照组。随后的52%的辍学率使89名妇女“完成”CBT组和43名对照组;这两组在人口统计学变量上匹配良好。意向治疗分析显示平均基线EPDS评分相对较低（平均值6.88 - 8.16），从时间点I至时间点4，两组的EPDS评分均未降低。在时间1，所有参与者中有19%的人符合MINI抑郁标准，但两组的抑郁症都没有减少;相比之下，CBT组中患有MINI焦虑症的人从妊娠晚期的28%减少到产后4个月的16%，对照组也有类似的减少。对132名“完成者”的分析显示，CBT组和对照组的症状随着时间的推移都有显着改善。症状最明显的女性的抑郁评分（EPDS > 12; N = 19）在整个时间过程中稳定下降超过50%，但CBT和对照组之间的改善没有差异。局限性：一些方法学因素可能掩盖了我们的结果，包括轻度症状受试者的自然缓解趋势，以及我们的对照条件在治疗中的可能性。结论：虽然在研究“完成者”中注意到抑郁评分的适度降低，但CBT组干预控制条件同样有益。这一发现的原因包括基线时的低症状水平;控制条件的潜在有效性;以及干预的简短性。(C)2007年由Elsevier B.V出版
Background: The majority of randomised controlled trials examining the effectiveness of antenatal group interventions at preventing postnatal depression in "at risk" women have used a "psychoeducational" intervention. The aim of the present study is to evaluate the effectiveness of an antenatal cognitive behavioural,group intervention in a primary care setting for pregnant women identified with mild to moderate symptoms in pregnancy and/or at risk of developing depression or anxiety in the perinatal period.Method: Subjects were randomised to a CBT group intervention or control condition (information booklet) and administered the EPDS and STAI at pre (Time 1) and post intervention (Time 2), and at 2 months (Time 3) and 4 months postpartum (Time 4). MINIs were administered at Times 1, 3 and 4.Results: Of the 774 women approached, 277 accepted and were suitable; thus 191 were randomised to the CBT intervention and 86 to the control condition. The subsequent 52% drop-out left 89 women "completing" the CBT groups and 43 in the control group; these two groups were well matched on demographic variables. Intention to treat analyses revealed relatively low mean baseline EPDS scores (means 6.88 -8.16) with no reduction in EPDS scores in either group from Time I to Time 4. MINI depression criteria were fulfilled by 19% of all participants at Time 1 but there was no reduction in depression in either group; in contrast those with MINI anxiety diagnoses reduced from 28% in late pregnancy to 16% at four months postpartum in the CBT group with similar reductions in the control group. Analyses on the 132 "completers" showed significant symptomatic improvement over time for both the CBT group and control condition. Depression scores in the most symptomatic women (EPDS > 12; N = 19) decreased steadily by over 50% over the total time course but there were no differences in improvement between the CBT and control groups.Limitations: A number of methodological factors may have obscured our results including a tendency to natural remission in mildly symptomatic subjects and the possibility that our control condition was therapeutic in itself.Conclusion: While a modest reduction in depression scores was noted in study "completers", both the CBT group intervention control condition were equally beneficial. The reasons for this finding include the low symptom level at baseline; the potential effectiveness of the control condition; and the brevity of the intervention. (C) 2007 Published by Elsevier B.V