Background. Social support theory and observational risk factor studies suggest that increased
antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge
of risk and protective factors for post-natal depression not employed previously in order to develop
and evaluate an antenatal preventive intervention.
Methods. We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened
1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable
or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization,
of these 190 provided outcome data 3 months post-natally. ‘Preparing for Parenthood’, a
structured antenatal risk factor reducing intervention designed to increase social support and
problem-solving skills, was compared with routine antenatal care only. We compared the
percentage depressed at 3 months after childbirth using the self-completion General Health
Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the
Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview.
Results. Assignment to the intervention group did not significantly impact on post-natal depression
(odds ratio for GHQ-Depression 1·22 (95% CI 0·63–2·39), P = 0·55) or on risk factors for
depression. Forty-five per cent of the intervention group women attended sufficient sessions to be
likely to benefit from intervention if effective. Attenders benefited no more than non-attenders.
Conclusions. Prevention services targeting post-natal depression should not implement antenatal
support programmes on these lines until further research has demonstrated the feasibility and
effectiveness of such methods. The development of novel, low cost interventions effective in reducing
risk factors should be completed before further trial evaluation.