In 1995 NHMRC funded a randomised, single blind control trial of a brief intervention using a specially devised, structured interview (The Maternal Individual Debriefing Schedule (MIDS) to see if stress debriefing after childbirth could reduce the prevalence of postnatal disorders.

Aims: To investigate maternal outcomes in the year after delivery of a full term infant , following a stress debriefing intervention

Method: 1755 English speaking mothers were randomly allocated to an intervention group or a control group. Research midwives trained to use the MIDS held a discussion session with women in the intervention arm, whilst they were in hospital, within 96 hours of delivery of a full term infant. Maternal outcomes were assessed by self report questionnaires (Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ-28), after delivery and at 2 and 6 months. All mothers who scored above 12 on the EPDS along with a stratified, random sample of those scoring below 13, were interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS) ,by a Research Clinical Psychologist blind to intervention status. Research Diagnostic Criteria were used to used to diagnose clinical disorders.

Results: 882 women were debriefed (Intervention Group) and 873 were controls. There were no significant differences between groups in gestation,parity, previous history of psychological disorder, demographic measures, type of labour and delivery, or maternal ratings of labour, and delivery. Nor were there differences on the EPDS, BDI or GHQ28 at any assessment period. By 6/12 post delivery 498/1755 women had been interviewed on the SADS. Diagnoses were: Depression (Major or Minor) 274 (15.6%); Stress Disorders 95(5.4); GAD12(0.07%);Phobic 35

( 2.0%) Panic Disorder 20 (1.1%);Other 109 (6.2%). When data was combined across two assessment periods and diagnosis of Major and Minor Depression were grouped together there were no significant differences in diagnostic outcomes between the group who were debriefed and the controls.

However further analyses of groups broken down by diagnosis at each assessment , revealed a significant effect of the intervention in relation to women who became depressed. By 6/12 there were twice as many women in the Intervention Group with Minor Depression and half as many with Major Depression. Women with a negative perception of their labour and delivery, and those with a prior history of contact with a mental health professional, were more likely to receive a diagnosis of Depression but there were no significant interaction effects on these variables across the Intervention and Control groups on these variables. (Adjusted OR .890 ; 95%CI .68-1.16)

Conclusions:

Psychological disorders are common after term delivery. A single stress debriefing intervention did not reduce the overall prevalence of depression (combined Major and Minor) but it did alter the ratio of Major to Minor episodes. Women who were debriefed were more likely to be diagnosed with Minor Depression rather than Major Depression by 6/12 post delivery when compared with controls.