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Peer Phone Calls Prevent Postpartum Depression in at-Risk Mothers
Daniel J. DeNoon
Reviewed By Louise Chang, MD
Jan. 15, 2009 -- Phone calls from volunteer mothers who overcame postpartum depression prevent depressive symptoms in at-risk mothers, a Canadian study shows.
"Mothers who received this support were at half the risk of depressive symptoms 12 weeks after delivery," says study leader Cindy-Lee Dennis, PhD, Canada research chair in perinatal community health at the University of Toronto.
It's the first big study to show that postpartum depression can be prevented without intensive home care, Dennis says.
The study included 701 women at risk of postpartum depression. Half got standard postnatal care and half got peer support. With standard care, 25% of the mothers had significant depressive symptoms 12 weeks after delivery. About half as many women who got peer support -- 14% -- had such symptoms.
After an extensive review of existing research, Dennis saw that efforts to prevent postpartum depression were most effective if begun soon after a woman gives birth -- and if they were home based.
But that's a problem: In Canada, as in the U.S., it's uncommon for health care workers to routinely visit families at home once they and their babies leave the hospital.
Dennis' solution: Recruit women who overcame postpartum depression, give them very brief training, and have them make regular telephone calls to at-risk women from two to 12 weeks after they gave birth.
"So we recruited mothers from the community who felt they had themselves experienced postpartum depression, so they know what it is like," Dennis tells WebMD. "Mothers are more willing to disclose their feelings to another mother who knows what it is like than to a doctor or nurse."
Training of the peers was intentionally brief.
"You don't want to overtrain them and make them paraprofessionals -- that would change the dynamics of the relationship," Dennis says. "We mostly talked with them about how to establish a relationship over the telephone and how to provide support. And we taught them how to identify depression so they could refer depressed women to professional care."
The peer support was intended not to replace professional help, but to serve as a link between communities and the health system.
Postpartum Depression: More Than Baby Blues
It's very common for women to have the baby blues in the first days after giving birth, says Diane Wulfsohn, PhD, a clinical psychologist at Atlanta's Northside Hospital. But those with significant depressive symptoms two weeks after delivery are at risk of postpartum depression.
"Depression in the past, prior postpartum depression, complicated pregnancy, and life difficulties or stress are red flags for postpartum depression," Wulfsohn says. "And postpartum depression is an umbrella term. It describes several mood reactions women can experience at this critical time of huge hormonal shifts."
Wulfsohn agrees with Dennis that in the U.S., there's no formal outreach system for identifying women who suffer postpartum depression. The stress is on making families aware of the symptoms and of making sure they know whom to call for help.
"There is no formal outreach, but in childbirth classes parents-to-be are told about these kinds of reactions," Wulfsohn says. "A lot of times a woman experiencing postpartum depression doesn't know what is going on, but the partner says, 'Oh, this is what they were talking about,' and calls me."
Dennis notes that many mothers are afraid to talk about their depression. They fear their children will be taken way and that they will be stigmatized as mentally ill. And even if they do want help, they may not have the time or resources to seek out professional care on their own.
That's where prenatal care plays a role, Wulfsohn says.
"One of the key things is awareness and education, and helping people feel postpartum depression is not a sign of weakness, and they are not the only ones who suffer it," she says. "That is probably the value of the Dennis program: women helping other women."
In-Home Therapy From Nurses Helps Postpartum Depression
Home care from nurses given brief psychotherapy training helps women overcome postpartum depression, a British study shows.
In the U.K., nurses called "health visitors" make regular calls on families before and long after a child is born. Even so, many women still suffer postpartum depression.
Training health visitors in "psychologically informed approaches for depression" helps these women overcome depression, find C. Jane Morrell, PhD, of the University of Huddersfield, England, and colleagues.
"The health visitors in our study were trained in psychotherapy techniques," Morrell tells WebMD. "Women cared for by the health visitors who received the training had fewer symptoms of depression when their babies were 6 months of age. That persisted to age 12 months."
The nurses were trained either in cognitive-behavioral or person-centered psychotherapy techniques. Each approach was equally helpful.
Dennis says the Morrell study shows how important it is to identify women who suffer postpartum depression.
"A lot of this depression still goes unrecognized and untreated. Why is that?" she asks.
The Dennis and Morrell studies appear in the Jan. 16 online first edition of the journal BMJ.
SOURCES: Morrell, C.J. BMJ, Jan. 16, 2009; online first edition. C. Jane Morrell, PhD, research leader, University of Huddersfield, England. Cindy-Lee Dennis, PhD associate professor and Canada research chair in perinatal community health, University of Toronto, Ontario, Canada. Diane Wulfsohn, PhD, clinical psychologist, department of behavioral health services, Northside Hospital, Atlanta.
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