| Popis: |
Background Maternal postnatal depression (PND) occurs following 10-15% of births. It is associated with a range of negative child outcomes. Risks for children are particularly increased when PND is persistent. We aimed to examine whether a parenting video-feedback treatment (VFT) versus a control treatment of progressive muscle relaxation (PMR), both added to cognitive behavioural therapy for persistent PND, led to better child cognitive, language, behavioural development and attachment at two years. Methods In this two-arm, parallel-design, individually randomised controlled trial, we recruited a community sample of 18-45 year old women living within 50 miles of Oxford between 4.5 and 9 months postnatally. All met diagnostic criteria for depression for at least three months, and had infants ≥ 35 weeks gestation, birthweight ≥ 2000 grams, and without serious neonatal complications. Through a centralised service, women were randomised using a minimisation algorithm, to either VFT or PMR, balanced for child gender, infant temperament, child age, socioeconomic status, and severity of depression. Both groups also received Cognitive Behavioural Therapy (CBT) for depression. Primary outcomes were child cognitive development, language, behaviour, and attachment at age two years. Secondary outcomes were maternal depression, and child emotion regulation, attention, and emotion discrimination. Parent-child interaction was also measured at baseline, end-of-treatment (one year) and two years. There were 11 home-based treatment sessions before child age one year, followed by two booster sessions in the second year. Assessors were blind to treatment arm allocation. Analyses were performed according to the intention-to-treat principle. Findings Between March 2011 and October 2013 we randomised 144 women, 72 to each group. Primary outcome data were available on 62-64 (86-89%) VFT and 67-68 (93-94%) PMR participants. There were no group differences in child outcome (adjusted difference, 95% C.I.: cognitive -1·01 (-5·11; 3·09), language 1·33 (-4·16; 6·82), behaviour -1·77 (-4·39; 0·85), attachment 0·02 (-0·06; 0·10)), with both groups achieving scores similar to non-clinical norms on all outcomes. There was marked improvement in maternal depression for both groups, with over 80% in remission at end-of-treatment and over 85% in remission at two years, but no difference between groups in clinical severity of depression rating on the Structured Clinical Interview for DSM IV R (CSR 0·31 (-0·26; 0·88)). There were no differences between the groups on the child secondary outcomes. There were six serious adverse events: 5 in the VFT group; 1 in the PMR group. None were treatment-related. Interpretation The impact of persistent PND on children is a major public health issue. For both treatments there was sustained remission from depression, and child development at outcome was in the normal range. The precise mechanisms cannot be determined from this study. |
