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5 results

  • Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial

  • Catherine Henderson, Simon Dixon, Annette Bauer, Martin Knapp, C. Jane Morrell, Pauline Slade, Stephen J. Walters, Traolach Brugha
  • Journal:
    Psychological Medicine / Volume 49 / Issue 8 / June 2019
    Published online by Cambridge University Press:
    30 August 2018, pp. 1324-1334
    • Article
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  • Background

    There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.

    Methods

    Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).

    Results

    In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).

    Conclusions

    PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.

  • Abortion

  • from Medical topics
  • Edited by Susan Ayers, University of Sussex, Andrew Baum, University of Pittsburgh, Chris McManus, Stanton Newman, Kenneth Wallston, John Weinman, Robert West
  • Book:
    Cambridge Handbook of Psychology, Health and Medicine
    Published online:
    18 December 2014
    Print publication:
    23 August 2007, pp 525-527

  • Summary

    Abortion

    Although induced and spontaneous abortion both involve the death of a fetus there are important differences in these experiences. In the former, pregnancy ends through an individual's choice while the latter is not because of, but often in spite of, the woman's and professionals' best efforts to save the baby. Women who have miscarried are often distressed by staff usage of the term ‘spontaneous’ abortion as this carries an unpleasant connotation and so this will be referred to as ‘miscarriage’ in this chapter.

    Miscarriage

    Up to 20% of recognized pregnancies end in miscarriage, defined as a pregnancy loss up to 24 weeks of gestation. Studies suggest that anxiety symptoms may be elevated for many months afterwards and a proportion of women may show depressive symptoms (Geller et al., 2004). Miscarriage has been compared to bereavement but the process of coping may be complicated by the abstract nature of the loss and the absence of memories of an individual. The loss is often hidden as many women will not have shared the news of their pregnancy at such an early stage and the support that unpleasant events often generates, may be absent. Our society lacks ritual acknowledgement of miscarriage and the prevailing view is often exemplified by the phrase ‘it was for the best’. A further aspect that is increasingly recognized is that miscarriage can be considered as a potentially traumatic experience. It clearly involves loss of life, and often fear, pain and loss of blood (Lee & Slade, 1996).

  • Psychological Therapy for Premenstrual Emotional Symptoms

  • Pauline Slade
  • Journal:
    Behavioural and Cognitive Psychotherapy / Volume 17 / Issue 2 / April 1989
    Published online by Cambridge University Press:
    16 June 2009, pp. 135-150
    Print publication:
    April 1989

  • Four women with cyclical changes in negative emotions related to their menstrual cycle were treated individually with a combination of psychological interventions, These included problem solving, autogenic training, and anxiety and anger control strategies. Cognitive issues and attributional patterns were also considered. Analysis of symptoms using permutation statistics indicated significant improvements. The problems of open trials and extrapolation from case reports are noted. Important clinical issues which arise in psychological intervention for premenstrual emotional symptoms are also considered.