Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression:
nationwide randomised controlled trial.Cindy-Lee Dennis, Sophie Grigoriadis, John Zupancic, Alex Kiss and Paula Ravitz
Background
Postpartum depression and anxiety are under-addressed public
health problems with numerous treatment access barriers,
including insufficiently available mental health specialist
providers.
Examine and explain the effectiveness of nurse-delivered telephone
interpersonal psychotherapy (IPT) for postpartum depression.
Method
Postpartum women (n= 241) with major depression (on the
Structured Clinical Interview for DSM-IV (SCID-I)) from 36
Canadian public health regions in rural and urban settings were
randomly assigned to 12 weekly 60 min nurse-delivered tele-
phone-IPT sessions or standard locally available care. The pri-
mary outcome was the proportion of women clinically depressed
at 12 weeks post-randomisation, with masked intention-to-treat
analysis. Secondary outcomes examined included comorbid
anxiety, self-reported attachment and partner relationship
quality.
Results
At 12 weeks, 10.6% of women in the IPT group (11/104) and 35%
in the control group (35/100) remained depressed (OR = 0.22,
95% CI 0.10–0.46), with the IPT group 4.5 times less likely to be
clinically depressed (SCID); 21.2% in the IPT group and 51% in the
control group had an Edinburgh Postnatal Depression Scale
(EPDS) score >12 (OR = 0.26, 95% CI 0.14–0.48), and attachment
avoidance decreased more in the IPT group than in the control
group (P= 0.02). Significant differences favoured the IPT group
for comorbid anxiety and partner relationship quality at all time
points, with no differences in health service or antidepressant
use. None of the IPT responders relapsed by 36 weeks. Between-
group SCID differences were sustained at 24 weeks, but not at 36
weeks.
Conclusions
Nurse-delivered telephone IPT is an effective treatment for
diverse urban and rural women with postpartum depression and
anxiety that can improve treatment access disparities.
Declaration of interest