Pragmatic randomized trial of antenatal intervention to prevent post-nataldepression by reducing psychosocial risk factors

Background. Social support theory and observational risk factor studies sug gest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and eval uate an antenatal preventive intervention. Methods. We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 s creen-positive women were untraceable or not eligible. Of 292 women who com pleted baseline assessment, 209 consented to randomization, of these 190 pr ovided outcome data 3 months post-natally. 'Preparing for Parenthood', a st ructured antenatal risk factor reducing intervention designed to increase s ocial support and problem-solving skills, was compared with routine antenat al care only. We compared the percentage depressed at 3 months after childb irth using the self-completion General Health Questionnaire Depression scal e and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for C linical Assessment in Neuropsychiatry a systematic clinical interview. Results. Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1.22 (95% Cl 0.63-2 .39), P = 0.55) or on risk factors for depression. Forty-five per cent of t he intervention group women attended sufficient sessions to be likely to be nefit from intervention if effective. Attenders benefited no more than non- attenders. Conclusions. Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further resear ch has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk fac tors should be completed before further trial evaluation.