This annual report - Taranaki District Health Board

Interventions for postnatal depressionInterventions for postnatal depression include psychotherapy, psycho-social interventionsand medication.Drug treatments for postnatal depression include anti-depressants, St. John’s Wort andhormone treatment. Selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine,paroxetine, and sertraline) and other antidepressants (e.g. nortryptyline) are effective forthe treatment of depression in general and, for this reason, the reviewers atclinicalevidence.bmj.com stated that, although there have been very few RCTs assessingthe effects of SSRIs or other antidepressants for the treatment of post-natal depression,they are likely to be beneficial for post-natal depression [483]. They found that there wasinsufficient evidence to draw any conclusions about hormones or St. John’s Wort.Regarding non-drug treatments, a 2009 Cochrane review assessed psychosocial andpsychological interventions for treating postpartum depression [484]. The review reportedon nine RCTs or quasi-RCTs which reported outcomes for 956 women. The psychologicalinterventions in the reviewed studies included cognitive behavioural therapy, interpersonalpsychotherapy, and psychodynamic therapy. The psychosocial interventions included peersupport and non-directive counselling, provided either by trained health workers or peervolunteers. The review authors concluded that, overall, psychological and psychologicalinterventions are effective treatments for postnatal depression although they reported thatthe methodological quality of the studies was, in general, not strong and it was unclearwhat the long term effects of these types of interventions were.A number of Cochrane reviews have examined preventive interventions for postnataldepression. These reviews found that there was insufficient evidence to draw anyconclusions about the benefits of hypnosis, antidepressant medication or psychological orpsychosocial interventions [485,486,487]. A review of two trials (229 women) found thatsynthetic progestogens do not prevent postnatal depression and that, because they have asignificant negative effect on maternal mood, it is questionable whether they should beprescribed for other indications, such as contraception, in the postnatal period [488].ConclusionChildren with mental health disorders are less able than adults with mental disorders totalk about their distress. They indicate their impaired mental health by their behaviour andthey do not usually choose to seek help from mental health services. Adults close to themnotice differences from normal age-appropriate behaviour and/or social and emotionalcompetence and seek help on their behalf.Parent-child relationships are critical to children’s social and emotional wellbeing and theirdevelopment of self-esteem, empathy, conscience, social and cooperative skills and thecapacity to manage their emotions and form successful adult relationships and becomecompetent nurturing parents. Poor quality parenting characterised by neglect,inappropriate expectations of child behaviour, harsh discipline and inadequate supervisionis associated with the development of conduct problems in children. Chronic stress in earlylife as a result of poverty, parental mental illness or substance abuse, domestic violenceand teen pregnancy can have lasting effects on a child’s developing brain and lead to poormental and physical health in later life. Children who exhibit anti-social behaviour early inlife are at risk of poor social and educational outcomes, mental illness, criminality, andsubstance abuse in later life. Compared to other OECD countries New Zealand has highrates of child abuse and neglect and children who have been abused or neglected arelikely to have persistent mental health problems.Around half of lifetime mental health disorders begin by the mid-teens. Prevention andintervention services are more effective in younger children but older children make up thevast majority of CAMHS clients. There are beginning to be some infant mental healthservices for very young children and their caregivers and there is increasing provision ofchild mental health services in primary care but there remains considerable unmet need forservices. When services focus only on those with the most severe disorders opportunitiesfor prevention and early intervention are lost.In-Depth Topic: Mental Health Issues in Children - 389