This annual report - Taranaki District Health Board

interventions to treat antenatal depression, which again included only one trial [282]. Thisthree-armed RCT, incorporating 61 outpatient antenatal women compared maternalmassage and acupuncture. No significant differences were identified between thetreatment arms immediately post-treatment or at 10 weeks postpartum.Psychosocial assessmentIn their Cochrane review, Austin et al. examined the impact of antenatal psychosocialassessment on perinatal mental health morbidity [283]. Two RCTs met the inclusioncriteria for the review. One study reported a RCT of 600 women identified as at significantrisk (on the basis of a set of psychosocial risk items) before being allocated antenatally toeither: the “intervention”, consisting of an Edinburgh Depression Scale (EDS) and adiscussion of their likely risk of postnatal depression based on their EDS score, aninformation booklet about postnatal depression and available local resources, and a lettersent back to the referring GP and Child Health Nurse, advising of their likely risk ofpostnatal depression; or “standard care”, including midwifery case management andreferral to social work or psychiatry as required. Follow up at four months postpartum usingthe EDS found no significant differences (RR 0.86, 95% CI 0.61 to 1.21). A large loss tofollow up (at least 27.1%) may have biased the results. The second study, focussed onproviders, reported a cluster RCT of 60 providers comparing the presence of psychosocialrisk factors in the early postnatal period in two groups of women: those with an antenatalhealth care provider administering the Antenatal Psychosocial Health Assessment(ALPHA), and those receiving “usual care”. The providers who assessed psychosocialfactors were more likely than those giving routine care to identify psychosocial concernsand to rate the level of concern as high and to detect concerns about family violence,however, none of these differences was statistically significant. The trial did not look at thedevelopment of anxiety or depression in these women. The authors concluded that whilethe use of an antenatal psychosocial assessment may increase the clinician’s awarenessof psychosocial risk, neither of these small studies provided sufficient evidence that routineantenatal psychosocial assessment by itself leads to improved perinatal mental healthoutcomes. Further research, which includes assessment of the longer term outcomes forthe both mother and family, is required.Psychosocial and psychological interventionsDennis et al. included 15 RCTs, involving over 6,700 women in their review assessing theeffectiveness of psychosocial and psychological interventions compared with usualantepartum, intrapartum, or postpartum care to reduce the risk of developing postpartumdepression [284]. Overall, women who received a psychosocial intervention were equallylikely to develop postpartum depression as those receiving standard care (RR 0.81, 95%CI 0.65 to 1.02). The provision of intensive postpartum support involving home visitsprovided by public health nurses or midwives appeared promising (2 trials, RR 0.68, 95%CI 0.55 to 0.84) and identifying mothers ‘at-risk’ was associated with a significant reductionin postpartum depression (7 trials, RR 0.67, 95% CI 0.51 to 0.89). Interventions with only apostnatal component appeared to be more beneficial (10 trials, RR 0.76, 95% CI 0.58 to0.98) than interventions that also incorporated an antenatal component. While individuallybasedinterventions may be more effective (11 trials, RR 0.76, 95% CI 0.59 to 1.00) thanthose that are group-based, women who received multiple-contact intervention were justas likely to experience postpartum depression as those who received a single-contactintervention. The authors conclude that while overall psychosocial interventions do notreduce the numbers of women who develop postpartum depression, the provision ofintensive, professionally-based postpartum support appears promising.Box 9. Key points emerging from the literature on interventions aimed at supportingwomen with mental illness in pregnancy UK and Australian guidelines have addressed caring for women with mental illnessduring pregnancy. Specialist multidisciplinary services involving maternity services,mental health services and community services are recommended. The small number of trials assessing the management of mental illness in pregnancymakes it difficult to draw conclusions.In-Depth Topic: Adversity in Pregnancy - 304