New research needed to identify and treat psychological illness in women after childbirth

Stress debriefing after childbirth does not reduce the incidence of psychological disorders in women in the following year, according to research published in the current edition of the Medical Journal of Australia. The research establishes that more work needs to be done to find a way to identify and treat women at risk of depression and psychological illness after giving birth.

The study revealed that almost one in five Australian children have a principle caregiver, who may be depressed for significant periods of the child's first year of life.

"Given the critical nature of the early attachment period, this has major public health implications," said researcher Dr Ronald Hagan, Neonatal Paediatrician at the King Edward Memorial Hospital in Perth.

Previous studies have suggested that women who perceive the birth of their children as a traumatic experience, are at greater risk of psychological disorders, including stress disorders.

"This has led to the introduction of debriefing after childbirth in Australian and overseas hospitals to help reduce psychological illness. However, recent trials of the effectiveness of this technique have given conflicting results," Dr Hagan said.

"In these trials midwives listened to women talk about their experiences in unstructured sessions.

"We conducted a trial to assess whether a short session of critical incident stress debriefing led by a midwife is effective in preventing postnatal psychological disorders," he continued.

The research was conducted by a team at the King Edward Memorial Hospital in Perth.

"It involved 1,745 women who delivered healthy term infants between April 1996 and December 1997 in two Perth hospitals. Eight hundred and seventy of these women formed a control group.

"An individual standardised debriefing session based on the principles of critical incident stress debriefing was carried out within 72 hours of delivery.

"Women were followed up with a rigorous, standardised clinical assessment, performed three times over a year.

"For over a quarter of women, this included a structured diagnostic psychological interview, which is a robust method of assessing psychological morbidity. These measures have been extensively validated and can provide accurate time of onset and duration.

"Our intervention may have failed because only one session was offered. It is possible that extra sessions targeted to those with more negative experiences might have had positive results, even though we showed no effect in subgroup analysis.

"In addition Perhaps psychiatric nurses could have provided more effective and skilled intervention than midwives, though the research midwives were experienced practitioners and had extensive training in structured debriefing.

"This is a very critical time in an infant's life so we must continue to develop and test interventions that reduce, or identify early, psychological problems in women after giving birth, and encourage early and effective treatment," said Dr Hagan.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Dr Ronald Hagan, 0410 419 313

Judith Tokley, AMA, 0408 824 306