Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors
Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors
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DOI：
10.1017/s0033291799002937
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发表时间：
2000-11-01
影响因子：
6.9
通讯作者：
Shapiro, DA
中科院分区：
文献类型：
--
作者：
Brugha, TS;Wheatley, S;Shapiro, DA
背景社会支持理论和观察性风险因素研究表明，增加产前心理社会支持可以预防产后抑郁症。我们使用经验知识的风险和保护因素的产后抑郁症没有就业以前，以制定和评估产前预防干预。我们在产前诊所进行了一项实用的随机对照试验。我们筛查了1300例初产妇，400例筛查阳性，69例筛查阳性的妇女无法追踪或不合格。在完成基线评估的292名妇女中，209名同意随机分组，其中190名提供了出生后3个月的结局数据。“为人父母准备”是一种结构化的产前风险因素减少干预措施，旨在增加社会支持和解决问题的技能，与常规的产前保健进行了比较。采用一般健康问卷抑郁量表、爱丁堡产后抑郁量表（EPDS）和神经精神病学临床评估量表对两组产后3个月抑郁的发生率进行比较。分配到干预组对产后抑郁症没有显著影响（GHQ抑郁症的比值比为1.22（95%CI 0.63-2.39），P = 0.55）或抑郁症的危险因素。45%的干预组妇女参加了足够的会议，如果干预有效，可能会受益。参加者并不比不参加者受益更多。针对产后抑郁症的预防服务不应按照这些方针实施产前支助方案，直到进一步的研究证明这些方法的可行性和有效性。在进一步试验评价之前，应完成有效降低风险因素的新型低成本干预措施的开发。
Background. Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention.Methods. We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. 'Preparing for Parenthood', a structured antenatal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview.Results. Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1.22 (95% Cl 0.63-2.39), P = 0.55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders.Conclusions. Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation.