Abstract
Depression in new mothers; causes consequences, and treatment alternatives
Kathleen A. Kendall-Tackett
New York: Haworth Press, 2005
ISBN-13: 978-0-7980-1839-7 pp. 255 + xv US$24.95
Kathleen Kendall-Tackett's clinical background as a psychologist and lactation consultant have placed her in good stead to write this book (an updated version of her previous book published in 1993) on post-partum depression, which affects approximately one in 10 women after giving birth.
The book is written in an easy-to-read and user-friendly format. It provides a wide-ranging and comprehensive overview of postnatal depression, including assessment and identification, risk factors, theories of aetiology, treatments (both alternative/complementary and conventional)and associated disorders such as anxiety disorders and bipolar disorder.
The author dispels the common myth that postnatal depression is not potentially serious – a fact backed by UK data identifying maternal mental health problems including depression as being the leading cause of maternal death [1]. There is also an emphasis throughout the book on the potential effect of depression on the mother–infant interaction (an extremely important area as we continue to become increasingly aware of the importance of this early relationship on subsequent infant development and potentially on adult psychopathology).
The layout is easy to use with simple headings such as “Why depression is harmful for mothers and babies” and there is a frequent use of illustrative case vignettes. It is a well-referenced book, with a pleasing amount of Australian and New Zealand studies quoted.
I was pleased to see that the author does not shy away from the hot topics of postnatal depression – in other words the controversial issues that end up being hotly debated in our perinatal multidisciplinary meetings! For example, is controlled crying (a sleep intervention during which parents allow their babies to cry for increasing periods of time before settling) a valid intervention for the treatment of postnatal depression as has been claimed by some studies, presumably through the resultant improved sleep for the mother, or is it a an potentially abusive practice that has been compared to “militaristic Nazi infant care”? Wisely the author allows the reader to reach their own conclusions!
My only criticism of the book is that at times it does not emphasize adequately important aspects of assessment and treatment. This is no doubt a consequence of the author trying to write a book that is user friendly and non-intimidating to readers not working in the mental health area. For example, there is a broad overview of many different therapies but with a relative emphasis on the alternative/complementary therapies as opposed to prescribed. It is true that mothers are often reluctant to take prescribed medication while breastfeeding, and are keen to explore other options as either as an alternative or as an adjunct – therefore as a psychiatrist working in the perinatal field I found the overview of holistic therapies useful. However, the relatively light coverage of the conventional psychotropic medications is a deficit in a book dealing with the treatment of postnatal depression. For a more comprehensive review of the use of psychotropic medications I would suggest Medications and mothers milk by Hale [2].
Similarly, past psychiatric history is of course the major risk factor for depression in the postnatal period, but is given insufficient priority, being listed in this chapter in the middle of a list of other risk factors. This is potentially confusing to non-mental health clinicians who may be using this text as a clinical resource; a fundamental part of assessing risk for postnatal depression includes taking a comprehensive past psychiatric history and this cannot be emphasized enough. The book would also benefit from more information on bipolar disorder, which is an important differential diagnosis particularly post-partum.
Despite the aforementioned criticisms this is a user-friendly and informative book that I enjoyed reading, and would recommend as a resource to mental health and other clinicians working with women in the postnatal period such as midwives, early childhood nurses, paediatric clinicians and lactation consultants. It could also be used as an excellent patient resource, either in excerpts or in its entirety, particularly its beginning chapter debunking some of the myths around postnatal depression that may hamper treatment. Its overview of the alternative options for therapy will also provide a useful supplementary resource for mental health clinicians making treatment plans for depressed mothers.
Liz Macdonald
Christchurch, New Zealand
© 2007 Liz Macdonald
Hands-on help. Computer-aided psychotherapy
Isaac Marks, Kate Cavanagh and Lina Gega
New York: Psychology Press, 2007
ISBN 978-1-84169-679-9 pp. 273 AU$43.95
The advantages of computer-delivered psychotherapy (CP) in meeting gaps in service provision are becoming increasingly clear to practitioners and to policy makers. The United Kingdom Secretary of State for Health, Patricia Hewitt, announced in March 2007 that all Primary Care Trusts in the UK would provide computerized cognitive behaviour therapy (cCBT) in its attempt to provide to the UK community greater access to psychological therapies. Two computer-based programs: one for anxiety (developed by Isaac Marks; FearFighter) and one for depression (developed by Judy Proudfoot; Beating the Blues) [1] have been endorsed for use.
The endorsement and promotion of CP by the UK government resulted in no small part from the development of research evidence about the efficacy and cost-effectiveness of these interventions. This new 272 page monograph by Isaac Marks and colleagues synthesis this vast research literature – summarizing the findings from “175 published and unpublished randomized controlled trials (RCTs), case reports, and small pilot and larger open studies of 97 CP” (p. 3).
The authors of this book focus on efficacy, effectiveness and cost-effectiveness of the trials of these systems. The book itself is divided into chapters that address the research areas of phobic/panic disorder, obsessive disorder and post-traumatic stress disorder, general anxiety, depression, eating problems, substance misuse, and pain and other miscellaneous adult problems. A final research chapter deals with CP for children and adolescents. The review covers the research trials in detail, with each chapter containing a brief summary, and a comprehensive table of the studies reviewed, describing the type of tool, design of the study, participants and outcomes. Despite its size, the literature on this topic suffers from the same problems that plague the broader literature involving psychological therapies in the treatment of psychiatric disorder. There is little head-to-head evaluation of cCBT and anti-anxiety or depression medication. Most trials compare the interventions to placebo, waitlist or treatment as usual. But the book is not simply a synthesis of the research literature. It addresses the advantages and disadvantages of computer-dedicated and Internet-based systems, the roles of face-to-face treatment and that of computer-assisted treatment, and it tackles issues of the integration of Web or Net systems into more traditional mental health services. There is discussion of the development of virtual clinics, the comparability of patients who use CP compared to other health options, and CP's place in health-care provision.
The book is likely to be a very useful resource for researchers, for practitioners, for those with an interest in the area, for human resource managers who might wish to purchase or acquire systems for their workplaces; and, perhaps, increasingly for policy makers. In the UK at least, there appear to be important drivers to the uptake of CP programs, with the business models to sustain these services based on a fee for service. In Australia these programs are largely provided as free access programs, with the costs largely being borne by the universities that have developed them. Government support of Web-based services under the Council Of Australian Government reforms in 2006 will be tested over the coming years. Hopefully, funding of these services will be driven by the type of research evidence provided by excellent research books such as this one.
Helen Christensen
Canberra, Australia
© 2007 Helen Christensen