title: Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling.
abstract: BACKGROUND
  Postnatal depression (PND) is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND) following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs) alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT), delivered by postnatal nurses or psychologists.
  
  
  METHODS
  This was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres) and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups.
  
  
  RESULTS
  Mean scores on the Beck Depression Inventory (BDI-II) at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028). However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%), and subsequent treatment uptake (40%) were low.
  
  
  CONCLUSIONS
  Data from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research.
authors: Department of Psychology, Psychological Sciences, University of Melbourne, Victoria 3010, Australia. jeannette.milgrom@austin.org.au
authors: Jeannette
authors: J
authors: Milgrom
authors: Christopher J
authors: CJ
authors: Holt
authors: Alan W
authors: AW
authors: Gemmill
authors: Jennifer
authors: J
authors: Ericksen
authors: Bronwyn
authors: B
authors: Leigh
authors: Anne
authors: A
authors: Buist
authors: Charlene
authors: C
authors: Schembri
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