Table 9Summary of study characteristics for trials of treatments for prevention of mental disorder versus standard care (risk factors identified)

Study ID (n = no. participants)Treatment (length of treatment)When?Risk factorBaseline (treatment/ control); % possible depressionMean age
ARMSTRONG19999 (n = 181)Multi-modal treatment (12 months)PNPsychosocial risk factors: one or more of: physical domestic violence, childhood abuse, sole parenthood, ambivalence to the pregnancy; or three or more of: <18 years, unstable housing, financial stress, <10 years’ education, low income, social isolation, history of mental health disorder (either parent), alcohol or drug misuse, non-physical domestic violenceMean (SD) EPDS 8.18 (4.95)/9.17 (5.57) 22% (EPDS > 12)Not given
BRUGHA2000 (n = 209)Group psychoeducation (6 weeks)AN/PN(Subthreshold) symptoms (presence of one of six depression items that indicated antenatal depression on modified GHQ)22%–23% scored ‘high’ on GHQ-D19
DENNIS2003 (n = 42)Social support (8 weeks)PN(Subthreshold) symptoms: EPDS > 9100% EPDS > 9; 20%/18% history of postnatal depression 100% (EPDS > 9)30
GAMBLE2005 (n = 103)Debriefing (one session)PNPTSD criterion ANot given28
GORMAN unpublished (n = 45)IPT (5 sessions)AN/PNPsychosocial risk factors or subthreshold symptoms: one or more of: history of treatment for depression, history of sustained period of depression or having a loss of interest or pleasure in activities, BDI > 12, first-degree relative with history of psychiatric treatment, marital/ partner relationship difficulties, 2 or more major life events occurring since beginning of pregnancyBDI > 12:
45.8%/47.6%
45.8%–47.6%
(BDI > 12)
28
HAGAN2004 (n = 199)CBT (6 weeks)PNPreterm or low birthweight babyMean (range) EPDS: 8 (4–12)/8 (4–11) Not given, but excluded if depressed29
HEINICKE1999* (n = 70)Multi-modal treatmentANPsychosocial risk factors (termed infant at risk of inadequate parenting by the study): 4+ needed: economic status, lack of support, unwanted pregnancy, childhood abuse, previous suicidal thoughts, previous mental health counselling/substance abuse treatment, homelessnessNot available24
HISCOCK2002* (n = 156)Infant sleep behavioural treatmentPNSevere infant sleep problemsEPDS mean (SD): treatment group 9.0 (0.44); control group 8.8 (0.49) 44%–45% (EPDS ≥10)34
HOROWITZ2001* (n = 122)Relationship/ attachment-based therapyPN(Subthreshold) symptoms: EPDS > 10100% EPDS > 1031
MARCENKO1994* (n = 225)Multi-modal treatmentANPsychosocial risk factors (termed infant at risk of inadequate parenting by the study): substance abuse, homelessness, domestic violence, psychiatric illness, incarceration, HIV infection, low social supportNot available23
MEYER1994 (n = 34)Multi-modal treatment (2–8 weeks)PNPreterm or low birthweight babyBDI ≥ 9: 31%–39%28
MIDDLEMISS1989* (n = 60)Home visitingANHigh risk of hospital admission due to obstetric problems; routinely treated by hospital admission: small-for-date foetus, previous perinatal loss, isolated small antenatal bleeds. None were thought to require immediate treatmentNot available28
RYDING2004 (n = 162)Debriefing (two sessions)PNEmergency caesareanNot available32
SMALL2000 (n = 1,041)Debriefing (one session)PNOperative deliveryNot availableNot given
STAMP1995 (n = 144)Social support (three sessions)AN/PNVulnerable to postnatal depression (modified antenatal screening questionnaire – unclear in paper which factors questionnaire focuses on)‘High’ on screening test: 18%/20%27
WEBSTER2003 (n = 600)Psychoeducation (unclear)ANPsychosocial risk factors: one or more of: low social or partner support, history of mental illness, family psychiatric history, previous postnatal depression, having a mother who had postnatal depressionEPDS > 12: 27.5%27
ZLOTNICK2001 (n = 37)IPT (4 weeks)ANPsychosocial risk factors or (subthreshold) symptoms: one or more of: previous episode of depression or postnatal depression, mild to moderate levels of depressive symptoms, poor social support, life stressor within last 6 monthsMean (SD) BDI: 11.06 (6.84); BDI > 10: 57%37
ZLOTNICK2006 (n = 99)IPT (4 weeks)ANPsychosocial risk factors or (subthreshold) symptoms: one or more of: previous episode of depression or postnatal depression, mild to moderate levels of depressive symptoms, poor social support, life stressor within last 6 monthsMean (SD) BDI: 15.3 (6.96)–% over threshold not given, allocated to > 45% group based on mean (SD)22
9

Reviewed studies, which are referred to by a study identifier consisting of primary author in capital letters and date of study publication

*

Studies not used because dichotomous outcomes not reported, although data from these studies are reported in the evidence profile (Appendix 19)

From: 6, PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS

Cover of Antenatal and Postnatal Mental Health
Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and Service Guidance.
NICE Clinical Guidelines, No. 45.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2007.
Copyright © 2007, The British Psychological Society & The Royal College of Psychiatrists.

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