Low income mothers who suffer from postnatal depression recover faster with a multifaceted approach, which includes psychoeducational groups and treatment adherence support, according to an article in this week’s The Lancet, a Latin American special edition.

Professor Ricardo Araya, Academic Unit of Psychiatry, University of Bristol, UK, and team looked at 230 mothers who had major depression and were going to postnatal clinics in Santiago, Chile.

Multicomponent Group
114 of the women were randomly selected to the multicomponent intervention group – this included a psychoeducational group, treatment adherence support, and pharmacotherapy when needed.

Standard Care Group
The rest, 116, received standard care usually available in the clinics – this included antidepressant medications, brief psychotherapeutic interventions, medical consultations, or external referral for specialized treatment.

At three and then six months after randomization, each woman was assessed using EPDS (Edinburgh Postnatal Depression Scale) – the lower the score, the less depressed the patient is.

The mean score for the multicomponent group at three months was 8.5, compared to 12.8 for the standard care group. At six months the multicomponent group scored 10.9, while the standard care group scored 12.5. Even though the gap closed somewhat at the six-month-point, the difference was still significant, explain the researchers.

“Our study has shown large and significant clinical improvements in low-income mothers with postnatal depression of moderate or greater severity who were allocated to multicomponent intervention compared with those in the usual care group…this study suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in some resource-poor countries,” the researchers wrote.

“Since so many health programmers in developing countries are focused around the perinatal period, this study provides a great opportunity to find ways of improving the recognition and treatment of postnatal depression and reducing its adverse effect of women and their children,” they concluded.

Accompanying Comment

“Araya and colleagues contribute to existing evidence and provide food for thought about the remaining challenges..despite a great deal of research in the past two decades, we still have much to learn about the design and implementation of effective, acceptable, and sustainable strategies for improving the mental health of women after childbirth.” wrote, Dr Rhonda Small and Dr Judith Lumley, Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia, in an Accompanying Comment.

“Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial”
Graciela Rojas MD, Rosemarie Fritsch MD, Jaime Solis MD, Enrique Jadresic MD, Cristóbal Castillo MD, Marco González MD, Viviana Guajardo MD, Prof Glyn Lewis PhD, Prof Tim J Peters PhD and Prof Ricardo Araya
The Lancet 2007; 370:1629-1637 – DOI:10.1016/S0140-6736(07)61685-7
Click here to view Abstract online

“Reduction of maternal depression: much remains to be done”
Dr Rhonda Small and Dr Judith Lumley
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Written by׃ Christian Nordqvist