title: Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care.
abstract: OBJECTIVE
  To evaluate benefits for postnatal women of two psychologically informed interventions by health visitors.
  
  
  METHODS
  Prospective cluster trial randomised by general practice, with 18 month follow-up.
  
  
  METHODS
  101 general practices in Trent, England.
  
  
  METHODS
  2749 women allocated to intervention, 1335 to control.
  
  
  METHODS
  Health visitors (n=89 63 clusters) were trained to identify depressive symptoms at six to eight weeks postnatally using the Edinburgh postnatal depression scale (EPDS) and clinical assessment and also trained in providing psychologically informed sessions based on cognitive behavioural or person centred principles for an hour a week for eight weeks. Health visitors in the control group (n=49 38 clusters) provided usual care.
  
  
  METHODS
  Score >or=12 on the Edinburgh postnatal depression scale at six months. Secondary outcomes were mean Edinburgh postnatal depression scale, clinical outcomes in routine evaluation-outcome measure (CORE-OM), state-trait anxiety inventory (STAI), SF-12, and parenting stress index short form (PSI-SF) scores at six, 12, 18 months.
  
  
  RESULTS
  4084 eligible women consented and 595 women had a six week EPDS score >or=12. Of these, 418 had EPDS scores available at six weeks and six months. At six months, 34% women (93/271) in the intervention group and 46% (67/147) in the control group had an EPDS score >or=12. The odds ratio for score >or=12 at six months was 0.62 (95% confidence interval 0.40 to 0.97, P=0.036) for women in the intervention group compared with women in the control group. After adjustment for covariates, the odds ratio was 0.60 (0.38 to 0.95, P=0.028). At six months, 12.4% (234/1880) of all women in the intervention group and 16.7% (166/995) of all women in the control group had scores >or=12 (0.67, 0.51 to 0.87, P=0.003). Benefit for women in the intervention group with a six week EPDS score >or=12 and for all women was maintained at 12 months postnatally. There was no differential benefit for either psychological approach over the other.
  
  
  CONCLUSIONS
  Training health visitors to assess women, identify symptoms of postnatal depression, and deliver psychologically informed sessions was clinically effective at six and 12 months postnatally compared with usual care.
  
  
  BACKGROUND
  ISRCTN92195776.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA. j.morrell@hud.ac.uk
authors.forename: C Jane
authors.initials: CJ
authors.lastname: Morrell
authors.forename: Pauline
authors.initials: P
authors.lastname: Slade
authors.forename: Rachel
authors.initials: R
authors.lastname: Warner
authors.forename: Graham
authors.initials: G
authors.lastname: Paley
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Walters
authors.forename: Traolach
authors.initials: T
authors.lastname: Brugha
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Parry
authors.forename: Jon
authors.initials: J
authors.lastname: Nicholl
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy; D003152:Community Health Nursing / Q000193:education*; D019052:Depression, Postpartum / Q000451:nursing*; D004739:England; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018802:Patient-Centered Care; D011446:Prospective Studies; D011584:Psychology / Q000193:education*; D016896:Treatment Outcome; D055815:Young Adult