Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial

• Published in: The Lancet (British edition) 2007-11, Vol.370 (9599), p.1629-1637
• Main Authors: Rojas, Graciela, MD, Fritsch, Rosemarie, MD, Solis, Jaime, MD, Jadresic, Enrique, MD, Castillo, Cristóbal, MD, González, Marco, MD, Guajardo, Viviana, MD, Lewis, Glyn, Prof, Peters, Tim J, Prof, Araya, Ricardo, Prof
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Care Facilities; Antidepressants; Antidepressive Agents, Second-Generation - therapeutic use; Children & youth; Chile; Clinical outcomes; Clinical trials; Data analysis; Depression, Postpartum - classification; Depression, Postpartum - drug therapy; Depression, Postpartum - therapy; Developing countries; Drug abuse; Families & family life; Female; Fluoxetine - therapeutic use; Gender differences; Humans; Income; Industrialized nations; Internal Medicine; Intervention; LDCs; Mental depression; Mothers; Postpartum depression; Poverty; Primary Health Care; Psychology; Psychotherapy, Brief - methods; Severity of Illness Index
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(07)61685-7

Summary Background The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile. Methods 230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov , number NCT00518830. Findings 208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8·5 [95% CI 7·2–9·7] vs 12·8 [11·3–14·1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10·9 [9·6–12·2] vs 12·5 [11·1–13·8]). The adjusted difference in mean EPDS between the two groups at 3 months was −4·5 (95% CI −6·3 to −2·7; p