Skip to main content

Trajectories of long-term outcomes for postnatally depressed mothers treated with group interpersonal psychotherapy

Abstract

There is evidence that psychological treatments for postnatal depression are effective in the short-term; however, whether the effects are enduring over time remains an important empirical question. The aim of this study was to investigate the depressive symptoms and interpersonal functioning of participants in a randomised controlled trial (RCT) of group interpersonal psychotherapy (IPT-G) at 2 years posttreatment. The study also examined long-term trajectories, such as whether participants maintained their recovery status, achieved later recovery, recurrence or persistent symptoms. Approximately 2 years posttreatment, all women in the original RCT (N = 50) were invited to participate in a mailed follow-up. A repeated measures analysis of variance assessed differences between the treatment and control conditions on depression and interpersonal scores across five measurement occasions: baseline, mid-treatment, end of treatment and 3-month and 2-year follow-up. Chi-square tests were used to analyse the percentage of participants in the four recovery categories. Mothers who received IPT-G improved more rapidly in the short-term and were less likely to develop persistent depressive symptoms in the long-term. Fifty seven percent of IPT-G mothers maintained their recovery over the follow-up period. Overall, IPT-G participants were significantly less likely to require follow-up treatment. Limitations include the use of self-report questionnaires to classify recovery. The positive finding that fewer women in the group condition experienced a persistent course of depression highlights its possible enduring effects after treatment discontinuation. Further research is needed to improve our long-term management of postnatal depression for individuals who are vulnerable to a recurrent or chronic trajectory.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Appleby L, Warner R, Whitton A, Faragher B (1997) A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. Br Med J 314:932–936

    Article  CAS  Google Scholar 

  2. Beck CT, Gable RK (2001) Comparative analysis of the performance of the postpartum depression screening scale with two other depression instruments. Nurs Res 50:242–250

    PubMed  Article  CAS  Google Scholar 

  3. Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II, Vol. Psychological Corporation, San Antonio, Psychological Corporation

  4. Boath E, Henshaw C (2001) The treatment of postnatal depression: a comprehensive literature review. J Reprod Infant Psychol 19:215–235

    Article  Google Scholar 

  5. Campbell SB, Cohn JF, Flanagan C, Popper S (1992a) Course and correlates of postpartum depression during the transition to parenthood. Dev Psychopathol 4:29–47

    Article  Google Scholar 

  6. Campbell SB, Cohn JF, Flanagan C, Popper S, Meyers T (1992b) Course and correlates of postpartum depression during the transition to parenthood. Dev Psychopathol 4:29–47

    Article  Google Scholar 

  7. Chen CH, Tseng YF, Chou FH, Wang SY (2000) Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan. J Psychosom Res 49:395–399

    PubMed  Article  CAS  Google Scholar 

  8. Cogill SR, Caplan HL, Alexandra H, Robson KM, Kumar R (1986) Impact of maternal postnatal depression on cognitive development of young children. Br Med J (Clin Res Ed) 292:1165–1167

    Article  CAS  Google Scholar 

  9. Cohen LS (1985) Measuring the functional components of social support. In: Sarason IG, Sarason BR (eds) Social support: Theory, research and applications. Martinus Nijhoff Publishers, Dordrecht, pp 73–94

    Google Scholar 

  10. Cooper PJ, Murray L (1995) Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry 166:191–195

    PubMed  Article  CAS  Google Scholar 

  11. Cooper P, Murray L (1997) Prediction, detection, and treatment of postnatal depression. Arch Dis Child 77:97–99

    PubMed  Article  CAS  Google Scholar 

  12. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786

    PubMed  Article  CAS  Google Scholar 

  13. Coyne JC, Gotlib IH (1983) The role of cognition in depression—a critical appraisal. Psychol Bull 94:472–505

    PubMed  Article  CAS  Google Scholar 

  14. Craig M, Howard LM (2009) Postnatal depression. Clin Evid (Online) 2009 website: http://clinicalevidence.bmj.com.virtual.anu.edu.au/ceweb/conditions/pac/1407/1407-get.pdf date accessed 6th May, 2009

  15. Cuijpers P, Brannmark JG, Van Straten A (2008) Psychological treatment of postpartum depression: a meta-analysis. J Clin Psychol 64:103–118

    PubMed  Article  Google Scholar 

  16. Dennis CL (2003) The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry 48:115–124

    PubMed  Google Scholar 

  17. Dennis CL (2004) Treatment of postpartum depression, part 2: a critical review of nonbiological interventions. J Clin Psychiatry 65:1252–1265

    PubMed  Article  Google Scholar 

  18. Dennis CL, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33:323–331

    PubMed  Article  Google Scholar 

  19. Dennis CL, Hodnett E (2007) Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev:CD006116

  20. Dennis CL, Kingston D (2008) A systematic review of telephone support for women during pregnancy and the early postpartum period. J Obstet Gynecol Neonatal Nurs 37:301–314

    PubMed  Article  Google Scholar 

  21. Feske U, Shear MK, Anderson B, Cyranowski J, Strassburger M, Matty M, Luther J, Frank E (2001) Comparison of severe life stress in depressed mothers and non-mothers: do children matter? Depress Anxiety 13:109–117

    PubMed  Article  CAS  Google Scholar 

  22. Fisher JR, Feekery CJ, Rowe-Murray HJ (2002) Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. J Paediatr Child Health 38:140–145

    PubMed  Article  CAS  Google Scholar 

  23. Frank E, Kupfer DJ, Wagner EF, McEachran AB, Cornes C (1991) Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression. Contributing factors. Arch Gen Psychiatry 48:1053–1059

    PubMed  Article  CAS  Google Scholar 

  24. Goodman JH, Santangelo G (2011) Group treatment for postpartum depression: a systematic review. Arch Womens Ment Health 14:277–293

    PubMed  Article  Google Scholar 

  25. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  Article  CAS  Google Scholar 

  26. Hammen C (2003) Social stress and women's risk for recurrent depression. Arch Womens Ment Health 6:9–13

    PubMed  Article  CAS  Google Scholar 

  27. Honey KL, Bennett P, Morgan M (2002) A brief psycho-educational group intervention for postnatal depression. Br J Clin Psychol 41:405–409

    PubMed  Article  Google Scholar 

  28. Huck SW (2008) Reading statistics and research: Fifth edition. Pearson Education, New York

    Google Scholar 

  29. Josefsson A, Sydsjo G (2007) A follow-up study of postpartum depressed women: recurrent maternal depressive symptoms and child behavior after four years. Arch Womens Ment Health 10:141–145

    PubMed  Article  CAS  Google Scholar 

  30. Matthey S (2004) Calculating clinically significant change in postnatal depression studies using the Edinburgh postnatal depression scale. J Affect Disord 78:269–272

    PubMed  Article  Google Scholar 

  31. Matthey S, Barnett B, Ungerer J, Waters B (2000) Paternal and maternal depressed mood during the transition to parenthood. J Affect Disord 60:75–85

    PubMed  Article  CAS  Google Scholar 

  32. McMahon C, Barnett B, Kowalenko N, Tennant C (2005) Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style. J Affect Disord 84:15–24

    PubMed  Article  Google Scholar 

  33. McMahon C, Trapolini T, Barnett B (2008) Maternal state of mind regarding attachment predicts persistence of postnatal depression in the preschool years. J Affect Disord 107:199–203

    PubMed  Article  Google Scholar 

  34. Milgrom J, Negri LM, Gemmill AW, McNeil M, Martin PR (2005) A randomized controlled trial of psychological interventions for postnatal depression. Br J Clin Psych 44:529–542

    Article  Google Scholar 

  35. Millon T, Davis R, Millon C (1997) Millon clinical multiaxial inventory-III (MCMI-III) manual, 2nd edn. NCS Pearson Inc, Minneapolis

    Google Scholar 

  36. Mulcahy R, Reay RE, Wilkinson RB, Owen C (2010) A randomised control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression. Arch Womens Ment Health 13:125–139

    PubMed  Article  Google Scholar 

  37. Muller ME (1994) A questionnaire to measure mother–infant interaction. J Nurs Meas 2:129–141

    PubMed  CAS  Google Scholar 

  38. Nylen KJ, O'Hara MW, Brock R, Moel J, Gorman L, Stuart S (2010) Predictors of the longitudinal course of postpartum depression following interpersonal psychotherapy. J Consult Clin Psychol 78:757–63

    PubMed  Article  Google Scholar 

  39. O'Hara MW, Neunaber DJ, Zekoski EM (1984) Prospective study of postpartum depression: prevalence, course, and predictive factors. J Abnorm Psychol 93:158–171

    PubMed  Article  Google Scholar 

  40. Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry 159:43–47

    PubMed  Article  Google Scholar 

  41. Pearlstein T (2008) Perinatal depression: treatment options and dilemmas. J Psychiatry Neuroscience 33:302–318

    Google Scholar 

  42. Pearlstein TB, Zlotnick C, Battle CL, Stuart S, O'Hara MW, Price AB, Grause MA, Howard M (2006) Patient choice of treatment for postpartum depression: a pilot study. Arch Womens Ment Health 9:303–308

    PubMed  Article  CAS  Google Scholar 

  43. Reay R, Matthey S, Ellwood D, Scott PM (2011) Long-term outcomes of participants in a perinatal depression screening program. J Affect Disord 129:94–103

    PubMed  Article  Google Scholar 

  44. Reay RE, Mulcahy R, Wilkinson RB, Owen C, Shadbolt B, Raphael B (2012) The development and content of an interpersonal psychotherapy group for postnatal depression. Int J Group Psychother 62:221–251

    Article  Google Scholar 

  45. Shapiro DA, Rees A, Barkham M, Hardy G, Reynolds S, Startup M (1995) Effects of treatment duration and severity of depression on the maintenance of gains after cognitive-behavioral and psychodynamic-interpersonal psychotherapy. J Consult Clin Psychol 63:378–387

    PubMed  Article  CAS  Google Scholar 

  46. Spanier G (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam 38:15–28

    Article  Google Scholar 

  47. Stuart S, Robertson M (2003) Interpersonal psychotherapy: A clinician's guide. Oxford University Press, New York

    Google Scholar 

  48. Viinamaki H, Niskanen L, Pesonen P, Saarikoski S (1997) Evolution of postpartum mental health. J Psychosom Obstet Gynecol 18:213–219

    Article  CAS  Google Scholar 

  49. Williams JB (1988) A structured interview guide for the Hamilton depression rating scale. Arch Gen Psychiatry 45:742–747

    PubMed  Article  CAS  Google Scholar 

  50. Wisner KL, Parry BL, Piontek CM (2002) Clinical practice. Postpartum depression. N Engl J Med 347:194–9

    PubMed  Article  Google Scholar 

  51. Wisner KL, Perel JM, Peindl KS, Hanusa BH (2004) Timing of depression recurrence in the first year after birth. J Affect Disord 78:249–52

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Rebecca E. Reay.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Reay, R.E., Owen, C., Shadbolt, B. et al. Trajectories of long-term outcomes for postnatally depressed mothers treated with group interpersonal psychotherapy. Arch Womens Ment Health 15, 217–228 (2012). https://doi.org/10.1007/s00737-012-0280-4

Download citation

Keywords

  • Postnatal depression
  • Interpersonal psychotherapy
  • Group psychotherapy
  • Long-term follow-up
  • Chronic depression