F. Teissedre

Prevention and treatment of post-partum depression: a controlled randomized study on women at risk

BACKGROUND Research is needed to evaluate the efficacy of prevention and treatment for post-partum depression. METHOD Subjects were screened with the Edinburgh Post-natal Depression Scale (EPDS) at the obstetric clinic. Mothers at risk (N = 258) (EPDS scores > or = 9) were randomly assigned to a prevention/treatment group or a control group. The prevention group received one cognitive-behavioural prevention session during hospitalization. At 4 to 6 weeks post-partum, subjects were screened again with the EPDS, after drop-out rates (refusals plus no return of the second EPDS) of 25.4% (33/130) in the intervention group and 10.9% (14/128) in the control group. Mothers with probable depression (EPDS scores > or = 11) were assessed using the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). Mothers with major depression continued in the treatment group (N = 18) or in the control group (N = 30). Treated subjects received a cognitive-behavioural programme of between five and eight weekly home-visits. RESULTS Compared with the control group, women in the prevention group had significant reductions in the frequency of probable depression (30.2 % v. 48.2%). Recovery rates based on HDRS scores of < 7 and BDI scores of < 4 were also significantly greater in the treated group than in the control group. CONCLUSIONS The study suggests that this programme for prevention and treatment of post-partum depression is reasonably well-accepted and efficacious.

Detecting women at risk for postnatal depression using the Edinburgh Postnatal Depression Scale at 2 to 3 days postpartum

Objective: This study evaluates the capacity of the Edinburgh Postnatal Depression Scale (EPDS) implemented in the first days postpartum to detect women who will suffer from postnatal depression. Method: A sample of 1154 women completed the EPDS at 2 to 3 days postpartum and again at 4 to 6 weeks postpartum. Results: There was a highly significant positive correlation between EPDS scores on both occasions (Spearman rank correlation: r = 0.59, P < 0.0001). The cut-off scores of 10 and 11 for EPDS administered at 2 to 3 days obtained good specificity, sensitivity, and positive predictive values for the cut-off scores proposed for the diagnosis of postnatal depression at 4 to 6 weeks postpartum. Conclusion: The EPDS completed at 2 to 3 days postpartum is a useful means of detecting women at risk of postnatal depression.

Étude de l'EPDS (Échelle postnatale d'Edinburgh) chez 859 mères : dépistage des mères à risque de développer une dépression du post-partum

Resume Cette etude traite de la validation d’une version francaise de l’ Edinburgh Postnatal Depression Scale (EPDS, Cox et al., 1987). Les objectifs de cette etude consistent a evaluer, dans les premiers jours apres l’accouchement, la valeur du seuil predictif d’une depression du post-partum avec l’EPDS et de preciser son seuil pour le depistage des depressions majeures du post-partum. Les passations ont ete realisees en 2 temps aupres de meres primipares et multipares dans 3 cliniques privees obstetricales du sud-ouest de la France. Les meres qui presentaient des problemes psychologiques et beneficiant d’un traitement etaient exclues de l’etude. Tout d’abord, l’echelle EPDS a ete remplie par 859 meres au 3 e jour apres leur accouchement. Puis, 722 meres ont a nouveau rempli cette echelle entre la 4e et la 6e semaine du post-partum. Parmi ces 722 meres, 131 presentaient une depression du post-partum. Le diagnostic de depression a ete corrobore par la Beck Depression Inventory (BDI, Beck, 1972), l’echelle de depression de Hamilton (HDRS, Hamilton, 1967) et le MINI ( Mini Neuropsychiatric Interview , Lecrubier et al. 1997). Au 3 e jour post-partum, nous notons 30 % de meres dont les scores EPDS sont9 et 19 % dont les scores EPDS sont11. Entre la 4 e et la 6 e semaine post-partum, nous observons 18,1 % de depression du post-partum, dont 16,8 % de depression majeure du post-partum. Les analyses factorielles indiquent, au 3 e jour du post-partum, une structure composee de 2 sous-echelles, et dans l’evaluation de la depression du post-partum une structure monofactorielle. L’etude de la sensibilite et de la specificite au 3 e jour post-partum prevoit le score de 9 (sensibilite : 0,88) (specificite : 0,50) comme la valeur du seuil predictif de depression post-partum. L’etude de la sensibilite et de la specificite entre la 4 e et la 6 e semaine post-partum prevoit un seuil de 12 pour le depistage des depressions majeures du post-partum (sensibilite : 0,91 et specificite : 0,74). L’etude de la fidelite confirme que l’echelle presente une bonne consistance interne (alpha de Cronbach > 0,80) aussi bien au 3e jour apres l’accouchement que dans l’evaluation de la symptomatologie depressive du post-partum evaluee a partir de la 4 e semaine du post-partum. Les resultats psychometriques de l’EPDS sont tres satisfaisants. Cette echelle permet a la fois le depistage precoce des meres a risque de developper une depression postnatale et, dans les premieres semaines du post-partum, celui des meres presentant une depression du post-partum.

Acceptability of psychotherapy and antidepressants for postnatal depression among newly delivered mothers

Although some studies suggest the efficacy of psychotherapy or antidepressant drugs for postnatal depression, their acceptability has not been extensively studied. Four hundred and five women consecutively admitted in obstetrical clinics were questioned about acceptability of treatments for postnatal depression using a repeated measures design after delivery, during their stay at the clinic. Mothers completed questionnaires assessing the degree of acceptability of different therapies for postnatal depression before and after receiving information about the current knowledge on antidepressant for postnatal depression and breastfeeding. The different therapies proposed were: psychotherapy by consultation, psychotherapy by home visits and antidepressant medication. The acceptability of antidepressants was significantly lower than either mode of psychotherapy before information was presented about the effects of antidepressants on breastmilk and significantly more so again after the information was given to mothers.

Influence of mother's perceptions on the choice to breastfeed or bottle‐feed: perceptions and feeding choice

The aim of the study was to evaluate what perceptions predicted feeding choice. A questionnaire assessing the degree of agreement with statements about the advantages and disadvantages of breastfeeding or bottle‐feeding was developed from analysis of qualitative interviews. Two hundred and twenty‐five mothers completed this questionnaire after delivery and indicated the feeding method they chose. Exploratory factorial analyses extracted 10 factors, which were entered in regression analyses predicting the choice of a feeding method. Three factors were significant predictors of the choice of the feeding method : ‘breastfeeding physiological advantages for mothers’, ‘fear of dependency’ and ‘moral reasoning’. The former factor was the only factor that positively predicted breastfeeding, whereas the latter two positively predicted bottle‐feeding. Possible implications to education and prevention are discussed.