VULNERABILITY AND HEALTH

Vulnerability and Health



Vulnerability and Health

Vulnerability

Vulnerability refers to the inability to withstand the effects of a hostile environment. A window of vulnerability (WoV) is a time frame within which defensive measures are reduced, compromised or lacking.

Women with Postnatal Depression and Health Visiting Practice

The need for effective population-wide prevention approaches to depression, including mixed depression and anxiety, has been highlighted by the demonstration of undiminished population prevalence rates despite at least a twofold increase in the usage of evidence-based treatments. Prevention can be considered as avoiding future illness in those already at risk although disease free or, more strictly, as avoiding future illness for all the population, not just those at immediate risk, hence the term universal prevention. But how might this is achieved? A highly significant predictor of depression within adulthood is 'sub threshold' depression. Depression prevention through the extension of cognitive behavioural therapy (CBT) to at-risk adolescents who had symptoms that fell short of the threshold for case depression may be effective because sub threshold levels are highly predictive of depression. It is not known whether such skilful psychological approaches could also benefit a much wider range of people at risk of developing depression if delivered universally across an entire population to adults at all risk levels (Sagovsky 2007, 78).

In the UK all infants and all mothers, following childbirth, receive individual care from a specialist community nurse, known as a 'Health Visitor' (HV). In addition to supporting infant care, the HV has a role in maternal mental health that should involve establishing a relationship with the mother and the use of interpersonal and communication skills. However, such practitioners are given little more than basic mental health knowledge. Could train HVs in psychological skills benefit women under their care who were not at immediate risk? In this paper we report on the benefits for all non-depressed postnatal women randomized to receive support from primary care nurses with specialized training in psychologically informed approaches to health care, in a large pragmatic cluster randomized controlled and economic evaluation trial.

We have already reported on postnatal women in randomly allocated intervention group (IG) clusters cared for by an HV who had received additional training in postnatal mental health assessment and in one of two psychologically informed approaches that were compared to usual HV care. Clinical assessment and psychologically informed approaches were designed to be offered by intervention group HVs to women scoring positive on the Edinburgh Postnatal Depression Scale (EPDS) at 8 weeks following childbirth. The EPDS is a widely used self-report measure to identify women at risk of postnatal depression (PND) with good evidence of sensitivity and specificity and a score ranging from 0 to 30, consisting of eight depression and two anxiety items (Cuijpers 2004, 325).

Method

The main pragmatic cluster randomized trial design and methods, on which the present analysis is based, are reported in detail elsewhere. The present study involved assessing outcomes for women in 101 primary care practices (clusters) (in one region of England, serving a population of ...