Couple-based cognitive behavioural intervention more effective in preventing postnatal depression

Couple-based cognitive behavioural intervention (CBI) is more effective than CBI delivered to mothers alone or standard perinatal care for preventing postnatal depression, a study in Hong Kong has shown.

The study included 388 low-risk adult Chinese couples (mean age: 31.8 years for mothers, 33.9 years for fathers), who were first-time parents with uncomplicated singleton pregnancy in the second or third trimester, recruited through antenatal clinics at three regional public hospitals in Hong Kong between 30 May 2014 and 31 December 2015. The participants were randomized to receive couple-based CBI (n=134) or CBI for mothers alone (n=124), both given in addition to usual perinatal care, or usual perinatal care alone (n=130). [BJOG 2020;127:500-507]

At 6 weeks postpartum, the proportion of mothers at risk of postnatal depression (ie, Edinburgh Postnatal Depression Scale [EPDS] score ≥10) was 17.8 percent lower in the couple-based CBI vs control group (29.9 percent vs 47.7 percent; p=0.01). However, this effect was not maintained at 6 months or 12 months postpartum. The difference between couple-based and woman-based CBI was not significant at any of the three postpartum follow-up timepoints.

Depressive symptoms, measured by EPDS score, were significantly lower at 6 weeks postpartum among mothers in the couple-based CBI group compared with the women-only CBI group (mean difference, 1.46; p=0.03) or the control group (mean difference, 1.71; p=0.01). However, no significant differences were observed at 6 months and 12 months postpartum. EPDS scores also did not differ significantly between the women-only CBI group and the control group.

Contrary to the investigators’ expectation, couple-based CBI did not have any significant effect on fathers in terms of depression score or the risk of depression during the postnatal follow-up period.

The CBI programme evaluated in the study covers an overview of stressors in the postnatal period and the signs and symptoms of postnatal depression; cognitive restructuring techniques for modifying and challenging depressogenic thoughts in the postnatal period; problem-solving, goal-setting and decision-making skills for managing common neonatal problems; and communication skills to improve interpersonal relationships. Participants in the CBI groups attended a 3-hour antenatal session, followed by two 30-minute telephone follow-up sessions at 2 weeks and 4 weeks postpartum.  

In the couple-based CBI group, 88.1 percent of mothers and 76.1 percent of fathers completed both postpartum telephone follow-up sessions, while 90.3 percent of mothers and 85.1 percent of fathers completed at least one session. The mean duration of each telephone follow-up session was 24.3 minutes for mothers and 17.4 minutes for fathers.

In the women-only CBI group, 79 percent of mothers completed both telephone follow-up sessions, while 79.8 percent completed at least one session, with a mean duration of 26.6 minutes.

“To our knowledge, this is the first randomized controlled trial that evaluates couple-based CBI for postnatal depression among Chinese couples,” wrote the investigators from the Hong Kong Polytechnic University and the University of Hong Kong. “Our findings add to the growing evidence that couple-based CBI is associated with a statistically and clinically significant reduction in postpartum depression among low-risk mothers at 6 weeks postpartum.”

“Further study is needed to establish the type of strategies and interventions that would work best for preventing depression in fathers,” they added.