Redesigned community postpartum care to prevent and treat postpartum depression in women--a one-year follow-up study

Aim: To investigate the effect of a redesigned follow-up care programme on prevention and treatment of postpartum depression.

Background: Postpartum depression may have negative consequences on child development, maternal health and the relationship between parents. Early identification and treatment might prevent longer-term depression.

Design: A quasi-experimental post-test design with non-equivalent groups.

Method: The study population was postpartum women with a live-born child, residing in one of two municipalities in Norway. A total of 2247 women were enrolled: 1806 in the experimental municipality and 441 in the comparison municipality. Public health nurses (26) in the experimental municipality were trained to identify postpartum depression using the Edinburgh Postnatal Depression Scale and clinical assessment and to provide supportive counselling.

Measurements: The Edinburgh Postnatal Depression Scale at six weeks, three, six and 12 months postpartum and the Parenting Stress Index at 12 months postpartum.

Results: The redesigned postpartum care programme yielded a significant group difference in the Edinburgh Postnatal Depression Scale score at six weeks (p < 0.01), odds ratio (OR) 0.6, three months (p < 0.01), OR 0.4, six months (p < 0.01), OR 0.5 and 12 months postpartum (p < 0.01), OR 0.6. Women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months.

Conclusion: The findings of this study suggest that redesigned postpartum care comprising training of health professionals, increased focus on mental health problems and support for the parents is a useful approach to managing postpartum depression in the community.

Relevance to clinical practice: Public health nurses are well positioned to identify and treat depressed mothers and provide referrals when needed. A small investment in training nurses to identify and treat postpartum depression can be cost-effective in the longer term. These findings have implications for service delivery in public health.