Prenatal Depression: A Randomized Controlled Trial in the Emotional Health of Primiparous Women

The prevalence of postnatal depression (10%-15%) renders it a major public health problem not only for the depressed mother but also for the infant, who may suffer from behavioral disturbances and cognitive delays in later years. This study aimed at evaluating an educational intervention to alleviate postnatal depression and at generally measuring the prenatal and postnatal mood of primiparous women. A prospective, randomized controlled trial of an education intervention to reduce postnatal depression was conducted at three sites in Australia enrolling a total of 184 primiparous women. The intervention consisted of an information booklet on postnatal depression and an audiotape of one woman's journey through clinical postnatal depression. Mood was assessed once prenatally (12-28 weeks) and twice postnatally (8-12 weeks and 16-24 weeks) using the Scale for Assessment of Depression and Schizophrenia modified for pregnant and postnatal women (SADS-M). Demographic and social support data were also collected at enrollment. Comparisons between the control group and the intervention group revealed no differences; the educational intervention did not show any effect when women's mood was measured by the SADS-M. Overall, a general, significant, steady decrease of depressive tendencies was observed when the two postnatal assessments were compared to the prenatal measurements. Women were less depressed postnatally than prenatally. This overall improvement of mood was significant in most SADS-M items. The exceptions were discouragement, anxiety, anger, and irritability, which did not reach significance. Additional multivariate analyses revealed no relevant influence of social support or demographic variables on the changes in mood. The main results that the education intervention had no effect and women, overall, were more depressed prenatally than postnatally contributes further evidence to the view that the prenatal period is a separate entity from the postnatal period, with distinctive psychoneuro-endocrine pathways and, thus, suggesting different profiles of women's experience. This evidence indicates the necessity to screen, refer, and manage prenatal maternal mood as an entity in its own right, rather than as a window on the postnatal period.