Abstract/Summary

Aim: The purpose of the study was to investigate whether a supportive psychotherapeutic intervention which focussed on enhancing the quality of the other-infant relationship would prevent the development of postnatal depression (PND) and the associated impairments in parenting and adverse effects on child development. Background: Recent meta-analytic examinations report a modest preventive effect of psychological treatments for women vulnerable to the development of postnatal depression. However, given the strong evidence for an impact of PND on the quality of the mother-infant relationship and on child development, it is notable that there are limited data on the impact of preventive interventions on these outcomes. This is clearly a question that requires research attention. Accordingly, a randomized controlled trial was conducted of such a preventive intervention. Methods: A large sample of pregnant women was screened to identify those at risk of PND. 91 were randomly assigned to the index intervention and received home visits from research health visitors, and 99 were assigned to a control group who received normal care. In an adjacent area 76 women received the index intervention from trained NHS health visitors. The index intervention involved 11 home visits, two antenatally and nine postnatally. They were supportive in nature, with specific measures to enhance maternal sensitivity to infant communicative signals. Independent assessments were made at18 weeks postpartum, and at 12 and 18 months postpartum of maternal mood, maternal sensitivity in mother-infant engagement, and infant behaviour problems, attachment and cognition. Findings: The index intervention, whether delivered by research or NHS health visitors, had no discernible impact on maternal mood or the quality of the maternal parenting behaviours. Neither did it benefit the infant outcomes assessed. For girl children a benefit of the intervention was found for cognitive development. Overall the findings indicate that this approach to preventing PND cannot be recommended.