***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This project aim ed to evaluate the impact of a home visiting programme that targeted families where the child , for environmental reasons , was at great risk of poor health and developmental outcomes . METHODOLOGY Women in the immediate postpartum period were recruited to a r and omized double-blind controlled trial on the basis of self-reported vulnerability factors and were r and omly assigned to receive either a structured programme of nurse home visiting , supported by a social worker and paediatrician ( n = 90 ) , or assigned to a comparison group receiving st and ard community child health services ( n = 91 ) . Parenting stress and maternal depression were measured at enrollment and at 6 weeks . Preventive health behaviour , service satisfaction and home environment outcomes were tested at 6 weeks , as were child health outcomes . RESULTS At six weeks , women receiving the home-based programme had significant reductions in postnatal depression screening scores as well as improvements in their experience of the parental role and improvement in the ability to maintain their own identity . Maternal-infant interactions were more likely to be positive , with significantly higher ( better ) scores in aspects of the home environment related to optimal development in children , particularly maternal-infant secure attachment . Intervention group mothers were significantly more satisfied with the community child health service . CONCLUSIONS This form of intervention for families is effective in promoting secure maternal-infant attachment , preventing maternal mood disorder and is welcomed by the families receiving it . These findings may predict long-term benefits for the healthy development of children otherwise at risk of a range of poor health and development outcomes BACKGROUND Women who have suffered one episode of postpartum-onset major depression ( PPMD ) comprise a high-risk group for subsequent episodes . We conducted a double-blind , r and omized clinical trial to test the efficacy of nortriptyline in the prevention of recurrent PPMD . METHOD Nondepressed women who had at least one past episode of PPMD ( Research Diagnostic Criteria ) were recruited during pregnancy . Subjects were r and omly assigned to nortriptyline or placebo . Treatment began immediately postpartum . Each subject was assessed for 20 sequential weeks with the Hamilton Rating Scale for Depression and Research Diagnostic Criteria for recurrence of major depression . RESULTS No difference was found in the rate of recurrence in women treated with nortriptyline compared with those treated with placebo . Of 26 subjects who took nortriptyline preventively , 6 ( 0.23 , 95 % exact confidence interval [ CI ] = 0.09 to 0.44 ) suffered recurrences . Of 25 subjects who took placebo  , 6 ( 0.24 , 95 % exact CI = 0.09 to 0.45 ) suffered recurrence ( Fisher exact p = 1.00 ) . CONCLUSION Nortriptyline did not confer additional preventive efficacy beyond that of placebo . The rate of recurrence of PPMD ( one fourth of women ) was unacceptably high OBJECTIVE Postpartum depression affects between 10 and 15 percent of new mothers . These mothers are apprehensive about recurrence after later births . This study tested the efficacy of antidepressant medication administered during the postpartum period to prevent a recurrence of postpartum depression  among women who had suffered a previous episode . METHODS An open clinical trial was conducted at a university-based outpatient clinic treating pregnant and postpartum women with mood disorders . Study participants were 23 pregnant women who had at least one previous postpartum episode that fit DSM-III-R criteria for nonbipolar major depression without psychotic features . Postpartum monitoring for recurrence of depressive symptoms was compared with postpartum monitoring plus postbirth treatment with either the medication that had been effective for the previous episode or nortriptyline . The first dose was given within 24 hours of birth . The authors assessed recurrence of postpartum major depression by psychiatric examination and use of the Inventory to Diagnose Depression , a reliable self-report instrument . RESULTS A significantly greater proportion of the women who elected monitoring alone ( 62.5 percent ) suffered recurrence of major depression compared with the women who received monitoring plus medication ( 6.7 percent ) ( p = .0086 ) . CONCLUSIONS Prophylactic antidepressant treatment reduced the recurrence of postpartum major depression Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service UNLABELLED Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder . The objective of this study was to assess a midwife-led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms . METHOD Of 348 women screened for trauma symptoms , 103 met inclusion criteria and were r and omized into an intervention ( n = 50 ) or a control ( n = 53 ) group . The intervention group received face-to-face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum . Main outcome measures were posttraumatic stress symptoms , depression , self-blame , and confidence about a future pregnancy . RESULTS At 3-month follow-up , intervention group women reported decreased trauma symptoms , low relative risk of depression , low relative risk of stress , and low feelings of self-blame . Confidence about a future pregnancy was higher for these women than for control group women . Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum , but this result was not statistically significant . DISCUSSION A high prevalence of postpartum depression and trauma symptoms occurred after childbirth . Although most women improved over time , the intervention markedly affected participants ' trajectory toward recovery compared with women who did not receive counseling . CONCLUSIONS A brief , midwife-led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma , depression , stress , and feelings of self-blame . The intervention is within the scope of midwifery practice , caused no harm to participants , was perceived as helpful , and enhanced women 's confidence about a future pregnancy 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 r and omized 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 r and omization , of these 190 provided outcome data 3 months post-natally . ' Preparing for Parenthood ' , a structured antenatal risk factor reducing intervention design ed 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 Question naire 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 OBJECTIVES To investigate the effectiveness of a psychosocial intervention for the prevention of postnatal depression . DESIGN A controlled trial . METHOD Women expecting their first or second child and design ated as ' more vulnerable ' by the Leverton Question naire ( LQ ) or Crown Crisp Experiential Index ( CCEI ) were allocated to a  preventive intervention ( N = 47 ) or  control group ( N = 52 ) by expected date of delivery to provide groups expecting their babies around the same time . Women were assessed at 3 months postnatal . An additional group of women design ated as ' less vulnerable ' ( N = 88 ) were assessed to confirm the validity of the LQ as a vulnerability measure . RESULTS Question naire measures of mood in first-time mothers invited to the Preparation for Parenthood groups revealed significantly more positive mood than in the group receiving routine care . The median Edinburgh Postnatal Depression Scale ( EPDS ) score for those invited was 3 , compared to 8 for those not invited ( p < .005 ) . The diagnosis of depression using the Present State Examination revealed differences for both groups , though it reached statistical significance only with the first-time mothers . Only 19 % of the ' more vulnerable ' invited first-time mothers were ' borderline ' or ' cases ' at any time in the first 3 months postnatally compared to 39 % of those not invited . The Surviving Parenthood groups for second-time mothers were not successful . CONCLUSION Some depressions following childbirth can be prevented by brief interventions that can be incorporated with existing systems of antenatal classes and postnatal support groups BACKGROUND A prospect i ve epidemiology study evaluated the role of specific social and psychological variables in the prediction of depressive symptomatology and disorders following childbirth in a community sample . Measures of social support used previously in clinical ly depressed population s facilitated further comparison . METHODS Nulliparous pregnant women ( N = 507 ) were interviewed during pregnancy with the Interview Measure of Social Relationships ( IMSR ) and a context ual assessment of pregnancy-related support and adversity and 427 were followed up at 3 months postpartum with the 30-item GHQ , including six depression items . To establish the clinical representativeness of the GHQ , high GHQ scorers and a r and om sub sample of low scorers were interviewed using the SCAN . Regression models were developed using the  GHQ Depression scale ( GHQ-D ) , the IMSR and other risk factor data . RESULTS GHQ-D after childbirth was predicted by lack of perceived support from members of the woman 's primary group and lack of support in relation to the event becoming pregnant ; this held even after controlling for antenatal depression , neuroticism , family and personal psychiatric history and adversity . Informant-rated deficits in provision of social support also predicted later depression . The size of the primary social network group previously found to be related to depression in women , did not predict depressive symptom development . CONCLUSION Predictors of depressive symptom development differ from predictors of recovery from clinical depression in women . Interventions should be design ed to reduce specific deficits in social support observed in particular study population OBJECTIVE To test whether critical incident stress debriefing after childbirth reduces the incidence of  postnatal psychological disorders . DESIGN R and omised single-blind controlled trial stratified for parity and delivery mode . SETTING Two large maternity hospitals in Perth . PARTICIPANTS 1745 women who delivered healthy term infants between April 1996 and December 1997 ( 875 allocated to intervention and 870 to control group ) . INTERVENTION An individual , st and ardised debriefing session based on the principles of critical incident stress debriefing carried out within 72 hours of delivery . MAIN OUTCOME MEASURES Diagnosis of stress disorders or depression in the 12 months postpartum , using structured psychological interview and criteria of the Diagnostic and statistical manual of mental disorders , 4th edition . RESULTS Follow-up information was available for 1730 women ( 99.1 % ) , 482 of whom underwent psychological interview . There were no significant differences between control and intervention groups in scores on Impact of Events or Edinburgh Postnatal Depression Scales at 2 , 6 or 12 months postpartum , or in proportions of women who met diagnostic criteria for a stress disorder ( intervention , 0.6 % v control , 0.8 % ; P = 0.58 ) or major or minor depression ( intervention , 17.8 % v control , 18.2 % ; relative risk [ 9 
    Output:
    
Diverse psychosocial or psychological interventions do not significantly reduce the number of women who develop postnatal depression .
The most promising intervention is the provision of intensive , professionally based postpartum support