Psychological interventions, including cognitive behavioural therapy (CBT), interpersonal therapy (IPT), counselling and psychodynamic therapy delivered by trained personnel in the community.
Interventions were provided individually or in group settings.
Sessions lasted between 30 minutes and 2 hours for a duration of 4 weeks to 8 months.
About 13% of mothers experience postnatal depression (PND) in the first year after childbirth. Untreated PND can negatively affect mother-child bonding, shorten breastfeeding duration, lead to marital difficulties and increase the risk of future depression.
Women with PND [Edinburgh PND scale score (EPDS) >12 or Beck Depression Inventory (BDI or BDI-II) score ≥ 10]
Interventions should be delivered by trained providers.
These interventions may be provided by trained GPs or other clinicians such as psychologists. Ideally GPs should be familiar with the areas of expertise of their local network to ensure an appropriate referral.
Psychological interventions from a wide range of theoretical stances (CBT, IPT, counselling, and psychodynamic therapy) improve the depressed mood of women with PND.
Tips and challenges
- Group delivery of the intervention is as effective as one-on-one.
- Explain that PND is common and manageable. Offering websites for more information (see consumer resources) and answering questions are part of psycho-education and provide benefit.
- Anxiety is often a prominent feature of the woman’s presentation. The anxiety may be about not being the ‘perfect’ mother, e.g. breastfeeding issues or not having a tidy house, or about looking after a baby especially if the mother is inexperienced. These issues can be approached with cognitive therapy strategies, such as a combination of problem-solving and challenging unhelpful or unrealistic expectations.
- Organising consultations so that the woman’s partner is also present may be helpful.
- The quality of partner relationships post-delivery may suffer – efforts to improve this will help the woman and her partner. Partner depression is not as well recognised as PND but its incidence increases after the birth of a child. Problem solving this may involve ideas such as using baby-sitters to allow the woman and her partner to enjoy each other’s company without interruption.
- Intimate partner abuse may become evident for the first time during a woman’s pregnancy or escalate after a birth, and needs to be addressed separately.
- Good sleep patterns for the infant need to be encouraged at an age-appropriate stage. Assistance to set and maintain boundaries for children in terms of sleeping through the night and sleeping in their own bed may be needed.
- Sharing experiences with other women with PND in moderated meetings can provide uniquely powerful social and emotional support. Your local health network may provide such support groups.
- As exercise can help with depression, problem solving how to incorporate exercise is useful.
- More complicated PND presentations relating to past experiences of being parented and the changed dynamic of close relationships may be better assisted with interpersonal therapy.
NHRMC Level 1 evidence.