2002 International International Biennial Scientific Meeting

ANTENATAL GROUPS FOR PERINATAL ANXIETY AND DEPRESSION: PREVENTION OR EARLY INTERVENTION?

Marie-Paule Austin* and Judith Lumley**

* Royal Hospital for Women and School of Psychiatry, University of New South Wales, Sydney
** Centre for Study of Mothers' and Children's Health, Latrobe University, Melbourne

m.austin@unsw.edu.au

Aims: 1) to review the efficacy of antenatal group interventions aimed at reducing postnatal post-natal depression (PND) in "at risk" women.

2) to identify future research directions in the field of perinatal early intervention.

Methods: The five randomized controlled antenatal group intervention studies published to date, are reported.

Results: All 5 studies suffer from substantial limitations including small numbers; unrealistic effect sizes or no formal justification for sample size; large rates of study participation decline and/or intervention drop-out rates; and lack of adequate antenatal screening tools for identification of those "at risk" leading to the targetting of heterogeneous "at risk" samples. The majority of interventions were "educational" or supportive in approach with only one using a well validated psychological intervention, namely brief IPT.

Results for the "targeted" interventions were negative. A very small "indicated" intervention (Zlotnick et al. 2001) using a brief group IPT intervention in symptomatic women, showed a reduced rate of PND; this requires replication.

Conclusions: At this stage, there is little evidence to support the use of antenatal group interventions in heterogenous samples of women "at risk" for PND. However, we argue for a broader "perinatal" approach that includes aiming interventions at both perinatal anxiety and depression; rather than focussing on PND alone. Furthermore, we suggest research into structured interventions in homogeneous, symptomatic, subsets of women; ie. using an "indicated" - rather than "targeted" - approach. These studies will need to address the methodological limitations of prior studies and to assess efficacy both for antenatal symptoms/disorder as well as the prevention of postnatal morbidity, before concluding that antenatal interventions have no place in maternity care.