The prevention of postnatal depression: a narrative systematic review.

This systematic review assessed the success of randomized controlled trials of preventative interventions for postnatal depression (PND). Outcomes examined were estimates of PND prevalence. Methodological quality was determined through the examination of key components individually with independent data extraction by all three authors. Data sources included Medline, PsycINFO, Sociofile, CINAHL, COPAC, EMBASE, Cochrane library; hand searches and a newsletter requests for unpublished trials to the Marcé Society and Postpartum Support International. Twenty-one RCTs were included in this review. Nine of these trials demonstrated short-term preventative success (seven psychological and supportive interventions, one unpublished antidepressant trial and a calcium carbonate trial) but none provided any evidence of long-term success. Furthermore, the results of three of the psychological intervention trials should be viewed with caution due to a lack of methodological rigour. There is a need for future research into the prevention of PND to be tightly designed and maybe include an exploration of the experience of postnatal depression for multiparous women.

Women's views of antidepressants in the treatment of postnatal depression.

Little research has been carried out on the treatment of postnatal depression and clinicians must currently rely on general recommendations for the use of antidepressants. Antidepressant medication as the main treatment for depression in general practice has been shown to be effective when used as prescribed. However, research has shown that depressed patients consistently receive either no medication or consistently low doses of medication. This study will investigate women's experiences of taking antidepressant medication for postnatal depression. Thirty-five women with a clinical diagnosis of postnatal depression who had been prescribed antidepressant medication completed a questionnaire detailing their experiences of taking medication. Four open-ended questions and responses were discussed with the women. Of the 35 women who were prescribed medication, 4 chose not to take it because they were breast-feeding. Twenty of the women described finding medication helpful. Although only 4 women directly reported not taking antidepressants as prescribed, the comments made by a further 9 women suggest that compliance may have been poor. This study suggests a need to improve information about medication for postnatal depression. If this information is not provided, women are likely to continue to self-manage medication at a dosage that may be clinically ineffective.

The long-term follow-up of women treated for postnatal depression at a specialist day hospital compared to routine primary care.

BACKGROUND: Postnatal depression affects approximately 13% of childbearing women. There are very few specialist treatment centres, despite emerging evidence that these units are superior to routine primary care in the short term. We investigated the long-term benefits of treatment for postnatal depression at a specialist day unit, compared to routine primary care. METHODS: Women who took part in an earlier study of postnatal depression were invited to participate in this follow-up. Self-report questionnaires (the Work, Leisure and Family Life Questionnaire - Modified (WLFQ-M) and the Dyadic Adjustment Scale (DAS)) were administered, together with the revised Clinical Interview Schedule (CIS-R). Information was also obtained regarding subsequent children and depressive episodes since the initial study. RESULTS: Of the original cohort of 60 women, 23 agreed to participate in the follow-up. There were no significant differences between DAS and WLFLQ-M scores or ICD-10 diagnoses of depressive episode between the women who had previously received specialist care. However, the numbers were small and make conclusions difficult. Qualitative analysis suggests that treatment at a specialist unit is beneficial in the long term. CONCLUSION: Further, larger studies of the long-term benefits of specialist treatment need to be carried out. (Int J Psych Clin Pract 2002; 6: 199-203 ).

A case-control study of differences between regular and causal adult attenders in general dental practice.

OBJECTIVES: To assess whether adults attending a dental practice for regular dental care have better oral health than adults attending casually in response to a dental problem, and to explore the barriers to asymptomatic attendance. METHODS: An observational case-control study comparing the characteristics of 100 regular attenders with 100 causal attenders in one general dental practice in North Staffordshire. All study subjects were aged 18 years or over. Sociodemographic characteristics of the two groups were collated, including age, gender, social class, marital status, employment status and smoking status. The primary outcome measure was the observed number of teeth with dentinal caries diagnosed using bitewing radiographs. RESULTS: Regular attenders were observed to have better oral health with respect to dental caries and tooth mobility (p < 0.05). This was not explained by the observation that causal attenders were more likely than regular attenders to be male, aged 18-44 years, in social class III or IV. Secondary outcomes, including number of subjects with mobile teeth and teeth with > 30% bone-loss, were also significantly worse in the casual attenders. However, the median number of teeth present in both groups was 27. In regular attenders, the most common reason for attending was to 'keep the teeth' (96%). In casual attenders, 'fear/dislike of dental treatment' was the most frequent indicator of non-attendance (56%). CONCLUSIONS: In our study, adults who regularly attended general dental practice were shown to have better oral health, including less overall tooth decay, mobility and bone-loss, compared with adults who did not attend on a regular basis. Assuming this result to be externally valid, a challenge for the dental profession in the future will be to develop effective oral health promotion initiatives.

When the cradle falls: the treatment of postnatal depression in a psychiatric day hospital compared with routine primary care.

BACKGROUND: Postnatal depression affects one in ten women within 6 months of childbirth. The most effective treatment strategy for postnatal depression is not clear. METHODS: This prospective, naturalistic study of the treatment of postnatal depression compared 30 women treated at a specialised psychiatric day hospital with 30 women treated using routine primary care (RPC). Clinical, marital and social adjustment were assessed on three occasions over 6 months using: the Edinburgh Postnatal Depression Questionnaire (EPDS); the Clinical Interview schedule (CIS); the Anxiety Subscale of the Hospital Anxiety and Depression Scale; the Dyadic Adjustment Scale (DAS); and the Work Leisure and Family Life Questionnaire-Modified (WLFLQ-M). RESULTS: There were no significant differences between the two groups at baseline. However, there were significant differences in outcome at 3 and 6 months follow-up for all outcome measures except the DAS. At 6 month follow-up 21 of the PBDU group were no longer depressed compared with 7 of the RPC group. CONCLUSIONS: A specialised day hospital is a more effective treatment setting for postnatal depression than routine primary care. LIMITATIONS OF THE STUDY: The study is not an RCT, so systematic bias is possible. The sample size is relatively small and the duration of follow-up relatively short.

The rise and rise of proton pump inhibitor drugs: patients' perspectives.

The prescribing of proton pump inhibitor (PPIs) drugs has increased by 456% in the past 4 yr, despite no evidence of increased morbidity for gastrointestinal conditions. There has been no full explanation for this dramatic increase. Doctors attribute the rapid and apparently unjustified increase in prescribing of this new and expensive drug to patients' demands and not to the extensive advertising campaign. This paper presents the findings from interviews with 20 patients who were taking PPIs. The results revealed that the prescribing of PPIs was mainly initiated in primary care, with little evidence of overt patient demand for PPIs, influenced by the media or social contacts. Patients' perceptions and beliefs about PPIs are explored and discussed. Patients modified the prescribed regimen to suit their perceived needs. Patients felt PPIs were more effective than other drugs they had tried previously and expressed their concerns about stopping PPIs, or changing to another drug. However, despite these reservations, the majority of patients interviewed said they would change if their general practitioner (GP) suggested it. PPIs led some patients to abandon, or not to attempt, lifestyle changes. The consequences of this and the implications of the continued prescribing of PPIs are discussed.

Consulting the oracle: a Delphi study to determine the content of a postgraduate distance learning course in therapeutics.

AIMS: To determine the content of a distance learning course in therapeutics for general practitioners (GPs). METHODS: This paper reports the results of a three-round Delphi study. The respondent group comprised 21 GPs who were expert in their field. In the first round, the experts were interviewed to determine the knowledge, skills, competencies and attitudes required by GPs to prescribe effectively; the justification for, and scope of a distance learning course; and the preferred learning methods, format and methods of assessment. The first round generated 251 statements, which were collapsed into 108 statements covering thirteen domains. In the second and third rounds, a questionnaire was posted to the GPs. 95% responded to the second round questionnaire and agreed upon 86 statements, which were then collated into four domains. In the third round, 19 GPs rated each of the 86 statements on a five point scale. Consensus was reached for 99% of statements: 40 on the aims, design, format, organization and assessment of the course; and 45 on the knowledge and skills to be acquired by GPs who complete the course. RESULTS: The results revealed a consensus in favour of: modules at regular intervals some flexibility in meeting deadlines interaction among students for mutual support easy access to course tutors some face-to-face contact to complement distance learning material clear guidance on effective and safe prescribing emphasis on importance of 'people skills' CONCLUSIONS: The Delphi process can be used to determine the competencies required for continuing medical education in therapeutics.