Evidence profile - psychosocial & other treatments focusing on the improvement of various aspects of care

Forest plot identifierDescriptionStudy IdsQuality of included studiesConsistencyDirectnessOther factorsN treatment group/N controlEffect sizeLikelihood of clinically important effectOverall quality
Continuity of midwifery care (antenatal and postnatal) versus standard care
RMs 01.01Probable depression (EPDS >=13) at 2 months postpartum (completer)Waldenstrom2000 AusSIGN: 1++N/AAntenatal booking (12–16 weeks) through 1 month postpartumSparse data (−1)361/323RR = 1.33 (0.91, 1.94)Likely (favouring standard care)Moderate
RMs 01.02Depression symptoms (EPDS mean) at 1 month postpartum (self-report; ITT not including those excluded for medical reasons & lost to follow-up)Marks2003 UKSIGN: 1++N/AAntenatal booking (12–16 weeks) through 1 month postpartumSparse data (−1)/imprecise data (−1)38/34WMD = 1.62 (−0.72, 3.96)InconclusiveLow
RMs 01.03Depression symptoms (EPDS mean) at 3 months postpartum (self-report; ITT not inclusding those excluded for medical reasons & lost to follow-up)Marks2003 UKSIGN: 1++N/AAntenatal booking (12–16 weeks) through 1 month postpartumSparse data (−1)42/43WMD = −0.01 (−2.55, 2.53)UnlikelyModerate
RMs 01.04Leaving study early for any reasonMarks2003 UK
Waldenstrom2000 Aus
SIGN: 1++Significant heterogeneity: random effects model used (−1)Antenatal booking (12–16 weeks) through 1 month postpartumImprecise data (−1)546/552RR (random effects) = 1.24 (0.48, 3.16)InconclusiveVery low
Continuity of midwifery care (postnatal) versus standard care
RMs 02.01Probable depression (EPDS >=13) at 2 months postpartum (completer)Shields1997 UKSIGN: 1+N/APostpartum (unspecified)Sparse data (−1)426/362RR = 0.72 (0.54, 0.95)Likely (favouring continuity of care)Moderate
RMs 02.02Depression symptoms (mean EPDS) at 7 weeks postpartum (self-report; completer)Shields1997 UKSIGN: 1+N/APostpartum (unspecified)Sparse data (−1)426/362WMD = −0.9 (−1.59, −0.21)UnlikelyModerate
Continuity of midwifery care (postnatal) versus standard care (CLUSTER randomised trial)
RMs 03.01Probable depression (EPDS >=13) at 2 months postpartum (completer)Macarthur2002 UKSIGN: 1+N/APostpartum up to 3 monthsSparse data (−1)792/693RR = 0.68 (0.54, 0.85)Likely (favouring continuity of care)Moderate
RMs 03.02Leaving study early for any reasonMacarthur2002 UKSIGN: 1+N/APostpartum up to 3 monthsSparse data (−1)1087/977RR = 1.66 (1.04, 2.65)Likely (favouring standard care)Moderate
Community-based & primary care strategies versus standard care (CLUSTER randomised trial)
RMs 04.01Probable depression (EPDS >=13) at 2 months postpartum (completer)Lumley2006 Aus PASIGN: 1+N/APostpartum (unspecified)None6221/5027RR = 1.05 (0.96, 1.15)Likely (favouring standard care)High
RMs 04.02Depression symptoms (mean EPDS) at 6 months postpartum (completer)Lumley2006 Aus PASIGN: 1+N/APostpartum (unspecified)None6163/4769WMD = 0.08 (−0.23, 0.39)UnlikelyHigh
RMs 04.02SF-36 Mental Health Component score mean (completer)Lumley2006 Aus PASIGN: 1+N/APostpartum (unspecified)None5917/4761WMD = −0.33 (−0.81, 0.15)UnlikelyHigh
Check-up at 1 week postpartum versus check-up at 6 weeks postpartum
RMs 05.01Probable depression (EPDS >=13) at 3 months postpartum (self-report; completer)Gunn1998 AusSIGN: 1+N/APostpartum (to 6 weeks)Sparse data (−1)/imprecise data (−1)232/243RR = 1.24 (0.81, 1.9)InconclusiveLow
RMs 05.02Depression symptoms (mean EPDS) at 3 months postpartum (self-report; completer)Gunn1998 AusSIGN: 1+N/APostpartum (to 6 weeks)Sparse data (−1)232/243WMD = −0.1 (−1.06, 0.86)UnlikelyModerate
Hospital discharge 25–48 hours postpartum versus hospital discharge 4 days postpartum
RMs 06.01Depression symptoms (mean BDI) 1 month postpartum (self-report; completer)Carty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)49/38WMD = −2.48 (−4.87, −0.09)InconclusiveLow
RMs 06.02State anxiety (STAI) at 1 month postpartumCarty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)49/38WMD = −0.47 (−5.67, 4.73)InconclusiveLow
RMs 06.02Trait anxiety (STAI) at 1 month postpartumCarty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)49/38WMD = −2.93 (−7.83, 1.97)InconclusiveLow
Hospital discharge 12–24 hours postpartum versus hospital discharge 25–48 hours postpartum
RMs 07.01Depression symptoms (mean BDI) 1 month postpartum (self-report; completer)Carty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)44/49WMD = −0.85 (−2.28, 0.58)UnlikelyModerate
RMs 07.02State anxiety (STAI) at 1 month postpartumCarty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)44/49WMD = −2.39 (−7.06, 2.28)InconclusiveLow
RMs 07.02Trait anxiety (STAI) at 1 month postpartumCarty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)44/49WMD = −1.36 (−5.76, 3.04)InconclusiveLow
Hospital Discharge 12–24 hours postpartum versus hospital discharge 4 days postpartum
RMs 08.01Depression symptoms (mean BDI) 1 month postpartum (self-report; completer)Carty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)44/38WMD = −3.33 (−5.52, −1.14)InconclusiveLow
RMs 08.02State anxiety (STAI) at 1 month postpartumCarty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)44/38WMD = −2.86 (−8.59, 2.87)InconclusiveLow
RMs 08.02Trait anxiety (STAI) at 1 month postpartumCarty1990 CanSIGN: 1+N/AEarly postpartum (to 4 days)Sparse data (−1)/imprecise data (−1)44/38WMD = −4.29 (−9.05, 0.47)InconclusiveLow

From: APPENDIX 19, EVIDENCE PROFILES

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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