Can community midwives prevent antenatal depression? An external pilot study to test the feasibility of a cluster randomized controlled universal prevention trial.
BACKGROUND
Repeated epidemiological surveys show no decline in depression although uptake of treatments has grown. Universal depression prevention interventions are effective in schools but untested rigorously in adulthood. Selective prevention programmes have poor uptake. Universal interventions may be more acceptable during routine healthcare contacts for example antenatally. One study within routine postnatal healthcare suggested risk of postnatal depression could be reduced in non-depressed women from 11% to 8% by giving health visitors psychological intervention training. Feasibility and effectiveness in other settings, most notably antenatally, is unknown.


METHODS
We conducted an external pilot study using a cluster trial design consisting of recruitment and enhanced psychological training of randomly selected clusters of community midwives (CMWs), recruitment of pregnant women of all levels of risk of depression, collection of baseline and outcome data prior to childbirth, allowing time for women 'at increased risk' to complete CMW-provided psychological support sessions.


RESULTS
Seventy-nine percent of eligible women approached agreed to take part. Two hundred and ninety-eight women in eight clusters participated and 186 termed 'at low risk' for depression, based on an Edinburgh Perinatal Depression Scale (EPDS) score of <12 at 12 weeks gestation, provided baseline and outcome data at 34 weeks gestation. All trial protocol procedures were shown to be feasible. Antenatal effect sizes in women 'at low risk' were similar to those previously demonstrated postnatally. Qualitative work confirmed the acceptability of the approach to CMWs and intervention group women.


CONCLUSIONS
A fully powered trial testing universal prevention of depression in pregnancy is feasible, acceptable and worth undertaking.
Department of Health Sciences,Section of Adult Social and Epidemiological Psychiatry,University of Leicester,Leicester General Hospital,Gwendolen Road,Leicester,UK.
T S
TS
Brugha
Department of Health Sciences,Section of Adult Social and Epidemiological Psychiatry,University of Leicester,Leicester General Hospital,Gwendolen Road,Leicester,UK.
J
J
Smith
Division of Women's and Children's CMG,Leicester Royal Infirmary,Jarvis Building,Infirmary Square,Leicester,UK.
J
J
Austin
Department of Health Sciences,Section of Adult Social and Epidemiological Psychiatry,University of Leicester,Leicester General Hospital,Gwendolen Road,Leicester,UK.
J
J
Bankart
Division of Women's and Children's CMG,Leicester Royal Infirmary,Jarvis Building,Infirmary Square,Leicester,UK.
M
M
Patterson
Department of Health Sciences,Section of Adult Social and Epidemiological Psychiatry,University of Leicester,Leicester General Hospital,Gwendolen Road,Leicester,UK.
C
C
Lovett
Department of Health Sciences,Section of Adult Social and Epidemiological Psychiatry,University of Leicester,Leicester General Hospital,Gwendolen Road,Leicester,UK.
Z
Z
Morgan
School of Health Sciences,University of Nottingham,Queen's Medical Centre,Nottingham,UK.
C J
CJ
Morrell
Clinical Psychology - Ground Floor Whelan Building,Institute of Psychology Health and Society,University of Liverpool,Liverpool,UK.
P
P
Slade
D000328:Adult; D003153:Community Health Services; D003863:Depression / Q000517:prevention & control*; D003866:Depressive Disorder / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D055815:Young Adult
Depression; perinatal; pilot study; prevention; randomized controlled trial