Counselling in a general practice setting: Controlled study of heath visitor intervention in treatment of postnatal depression

Abstract

Objective - To determine whether counselling by health visitors is helpful in managing postnatal depression. Design - controlled, random order trial. Setting - Health centres in Edinburgh and Livingston. Patients - Sixty women identified as depressed by screening at six weeks post partum and by psychiatric interview at about 13 weeks post partum. Five women did not wish to participate, and a further five did not complete the trial. Age, social and obstetrics factors, and diagnosis were similar in women who completed the trial and those who withdrew. Intervention - Eight weekly counselling visits by health visitors who had been given a short training in counselling for postnatal depression. End point - Reduction of depression. Measurements and main results - Standardised psychiatric interviews and a 10 point self report scale were used to identify depression before and after intervention. The psychiatrist was not told to which group women were allocated. After three months 18 (69%) of the 26 women in the treatment group had fully recovered compared with nine (38%) of the 24 in the control group. The difference between the groups was thus 32% (95% confidence interval 5 to 58). Conclusions - Counselling by health visitors is valuable in managing non-psychotic postnatal depression.