Alan Stein1, Elena Netsi2, Peter J Lawrence3, Charlotte Granger2, Claire Kempton2, Michelle G Craske4, Alecia Nickless5, Jill Mollison5, D Anne Stewart2, Elizabeth Rapa2, Valerie West2, Gaia Scerif6, Peter J Cooper7, Lynne Murray7. 1. Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: alan.stein@psych.ox.ac.uk. 2. Department of Psychiatry, University of Oxford, Oxford, UK. 3. Department of Psychiatry, University of Oxford, Oxford, UK; Anxiety and Depression in Young People Clinical Research Unit, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK; Academic Unit of Psychology, University of Southampton, Southampton, UK. 4. Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA. 5. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK. 6. Department of Experimental Psychology, University of Oxford, Oxford, UK. 7. School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK; Psychology Department, Stellenbosch University, Matieland, Stellenbosch, South Africa; Department of Psychology, University of Cape Town, Rondebosch, Cape Town, South Africa.
Abstract
BACKGROUND:Maternal postnatal depression occurs following 10-15% of births and is associated with a range of negative child outcomes. Risks to children are particularly increased when postnatal depression is persistent. We aimed to examine whether a parenting video-feedback therapy (VFT) intervention versus a control treatment of progressive muscle relaxation (PMR), both added to cognitive behavioural therapy (CBT) for persistent postnatal depression, would lead to improved child outcomes at age 2 years. METHODS: In this two-arm, parallel-design, individually randomised controlled trial, we recruited a community sample of women aged 18 years or older living within 50 miles of Oxford, UK, between 4·5 and 9·0 months post partum. All participants met diagnostic criteria for current major depressive disorder that had persisted for at least 3 months and had infants at 35 or more weeks of gestation, with a birthweight of 2000 g or greater, and without serious neonatal complications. Through a centralised service, women were randomly assigned by use of a minimisation algorithm, to receive either VFT or PMR, balanced for child sex, temperament, age, socioeconomic status, and severity of depression. Both groups also received CBT for depression. Primary outcomes were child cognitive development, language development, behaviour problems, and attachment security at age 2 years. There were 11 home-based treatment sessions before child age 1 year, followed by two booster sessions in the second year. Assessors were masked to treatment group allocation. All analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN registry, number ISRCTN07336477. FINDINGS:Between March 18, 2011, and Dec 9, 2013, we randomly assigned 144 women, 72 to each group. Primary outcome data were available for 62-64 (86-89%) VFT and 67-68 (93-94%) PMR participants. There were no group differences in child outcome (cognitive development, adjusted difference -1·01 [95% CI -5·11 to 3·09], p=0·63; language development, 1·33 [-4·16 to 6·82], p=0·63; behaviour problems, -1·77 [-4·39 to 0·85], p=0·19; attachment security, 0·02 [-0·06 to 0·10], p=0·58), with both groups achieving scores similar to non-clinical norms on all outcomes. There were six serious adverse events: five in the VFT group (in two participants) and one in the PMR group. None was treatment-related. INTERPRETATION: The effect of persistent postnatal depression on children is a major public health issue. For both treatment groups there was sustained remission from depression, and child development outcomes were in the normal range. The precise mechanisms accounting for the observed positive child outcomes cannot be ascertained from this study. FUNDING: Wellcome Trust.
RCT Entities:
BACKGROUND:Maternal postnatal depression occurs following 10-15% of births and is associated with a range of negative child outcomes. Risks to children are particularly increased when postnatal depression is persistent. We aimed to examine whether a parenting video-feedback therapy (VFT) intervention versus a control treatment of progressive muscle relaxation (PMR), both added to cognitive behavioural therapy (CBT) for persistent postnatal depression, would lead to improved child outcomes at age 2 years. METHODS: In this two-arm, parallel-design, individually randomised controlled trial, we recruited a community sample of women aged 18 years or older living within 50 miles of Oxford, UK, between 4·5 and 9·0 months post partum. All participants met diagnostic criteria for current major depressive disorder that had persisted for at least 3 months and had infants at 35 or more weeks of gestation, with a birthweight of 2000 g or greater, and without serious neonatal complications. Through a centralised service, women were randomly assigned by use of a minimisation algorithm, to receive either VFT or PMR, balanced for child sex, temperament, age, socioeconomic status, and severity of depression. Both groups also received CBT for depression. Primary outcomes were child cognitive development, language development, behaviour problems, and attachment security at age 2 years. There were 11 home-based treatment sessions before child age 1 year, followed by two booster sessions in the second year. Assessors were masked to treatment group allocation. All analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN registry, number ISRCTN07336477. FINDINGS: Between March 18, 2011, and Dec 9, 2013, we randomly assigned 144 women, 72 to each group. Primary outcome data were available for 62-64 (86-89%) VFT and 67-68 (93-94%) PMR participants. There were no group differences in child outcome (cognitive development, adjusted difference -1·01 [95% CI -5·11 to 3·09], p=0·63; language development, 1·33 [-4·16 to 6·82], p=0·63; behaviour problems, -1·77 [-4·39 to 0·85], p=0·19; attachment security, 0·02 [-0·06 to 0·10], p=0·58), with both groups achieving scores similar to non-clinical norms on all outcomes. There were six serious adverse events: five in the VFT group (in two participants) and one in the PMR group. None was treatment-related. INTERPRETATION: The effect of persistent postnatal depression on children is a major public health issue. For both treatment groups there was sustained remission from depression, and child development outcomes were in the normal range. The precise mechanisms accounting for the observed positive child outcomes cannot be ascertained from this study. FUNDING: Wellcome Trust.
Authors: Selina Nath; Rebecca M Pearson; Paul Moran; Susan Pawlby; Emma Molyneaux; Louise M Howard Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2019-10-23 Impact factor: 4.328
Authors: Thomas G O'Connor; Michael T Willoughby; Jan A Moynihan; Susan Messing; Ana Vallejo Sefair; Jennifer Carnahan; Xiajuan Yin; Mary T Caserta Journal: Brain Behav Immun Date: 2019-05-03 Impact factor: 7.217
Authors: Joanna Maselko; Siham Sikander; Elizabeth L Turner; Lisa M Bates; Ikhlaq Ahmad; Najia Atif; Victoria Baranov; Sonia Bhalotra; Amina Bibi; Tayyaba Bibi; Samina Bilal; Pietro Biroli; Esther Chung; John A Gallis; Ashley Hagaman; Anam Jamil; Katherine LeMasters; Karen O'Donnell; Elissa Scherer; Maria Sharif; Ahmed Waqas; Ahmed Zaidi; Shaffaq Zulfiqar; Atif Rahman Journal: Lancet Psychiatry Date: 2020-09 Impact factor: 27.083
Authors: Neda Mortaji; John E Krzeczkowski; Khrista Boylan; Linda Booij; Maude Perreault; Ryan J Van Lieshout Journal: Am J Clin Nutr Date: 2021-10-04 Impact factor: 8.472
Authors: Elizabeth Murray; Michelle Fernandes; Charles R J Newton; Amina Abubakar; Stephen H Kennedy; Jose Villar; Alan Stein Journal: PLoS One Date: 2018-02-28 Impact factor: 3.240