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THE IMPACT OF PSYCHOLOGICAL TREATMENT OF POSTPARTUM DEPRESSION ON MATERNAL MOOD, THE MOTHER-INFANT RELATIONSHIP, AND

INFANT OUTCOME IN A LOW RISK SAMPLE

PETER COOPER, PH.D.

UNIVERSITY OF CAMBRIDGE CLINICAL SCHOOL, WINNICOTT RESEARCH UNIT FENNERS, GRESHAM ROAD, CAMBRIDGE, ENGLAND CB12ES

There has been little systematic research into the treatment of postpartum psychiatric disorders. One recent controlled trial of the treatment of non-psychotic postpartum depression revealed that remission could be significantly speeded up with brief home-based non-directive counselling. However, it is uncertain what the generality of treatment effects is with this form of intervention - in particular, whether there are any benefits in terms of the mother-infant relationship and infant emotional and cognitive outcome; and it is unknown whether other forms of treatment might have a greater or more general therapeutic effect. A treatment trial was therefore conducted comparing four forms of management in a community sample with major depressive disorder arising in the early weeks following a first delivery. The four forms of management, to which depressed women were randomly assigned, were non-directive counselling (_n = 42), an attachment psychotherapy (E = 40), cognitive behaviour therapy (_n = 41) and standard primary care (_n = 48) (with no intervention, other than assessment, by the research team). Treatment was delivered in the women’s homes on a weekly basis from eight to 18 weeks postpartum. Specialist and non-specialist therapists were used; and some therapists conducted more than one form of treatment.

There were no therapist or expertise effects.

Treatment had a powerfui anti-depressant effect. Compared to those who received standard primary care, those who received the psychological treatments improved significantly faster. This effect was no longer apparent nine months after delivery because natural remission had caught up with the treatment effect. There was no simple difference in terms of anti- depressant efficacy, between the three forms of treatment. However, there was an interaction between mode of treatment and previous psychiatric history. None of the treatments appeared to have any impact on the quality of the mother-infant relationship. Nevertheless, both early remission and treatment were associated with fewer maternai reports of infant probiems at i8 months postpartum; and early remission was associated with fewer insecurely attached children at this time. Neither early remission nor treatment had any impact on infant cognitive outcome.

These findings have implications for understanding the nature of the relationship between postpartum affective disorder and infant cognitive and emotional outcome. They also point to a need for the development and evaluation of preventative interventions.