Authors' objectives

To assess the effectiveness of a single session of debriefing or non-directive counselling in reducing depression and symptoms of trauma in women following childbirth.

Searching

The Cochrane Controlled Trials Register, PubMed, CINAHL (from 1982 to 2000), EMBASE, Sociofile and PsycLIT were searched for reports published in the English language. The search terms were stated. In addition, the reference lists from identified studies and reviews were examined, and some experts and authors in the field were contacted for information on conference proceedings.

Study selection

Assessment of study quality

Validity was not formally assessed, but some aspects of validity were discussed in the text. These included sample size, adequacy of description of the intervention, and the validity of the measure used to assess the outcome.

Data extraction

Two researchers extracted and tabulated data on study design, description of participants and intervention, outcomes measures, timing of follow-up and results.

Methods of synthesis

Results of the review

Three RCTs (2,906 women) were included.

Methodological limitations of the studies included the following: a small sample size in one RCT; use of the HAD scale, which has not been validated for use in postnatal women; the lack of a detailed description of the intervention; and the use of measures of depression rather than trauma.

The results were inconsistent. The two larger RCTs (2,786 women) found no statistically-significant difference in the rates of depression or improvement in health with a single debriefing session, compared with no debriefing. One of these RCTs (1,041 women) found that debriefing significantly reduced role functioning-emotional on the SF 36 subscale. The smallest RCT (120 women) found that debriefing significantly reduced the risk of high anxiety and depression.

Authors' conclusions

There was insufficient evidence about the effectiveness of a single debriefing session after childbirth. Further research is required.

CRD commentary

The review question was clear in terms of the intervention, participants and outcomes. Several relevant sources were searched, the search terms were stated and attempts were made to locate unpublished studies. By limiting the literature search to studies published in the English language, some relevant studies may have been omitted. Two reviewers independently selected the studies and extracted the data, which reduced the potential for bias and errors. Validity was not formally assessed, but some relevant aspects of study validity were discussed in the text. Relevant information on the included studies was tabulated. A narrative synthesis was appropriate given the small number of studies. Some differences between the studies and limitations of the included studies were discussed in the text of the review. The evidence presented appears to support the authors' conclusions.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice. Research: The authors stated that future research should include a large sample representative of birthing women, clearly describe the type of intervention, and measure maternal trauma symptoms, anxiety and adjustment to the parenting role. They also stated that the outcomes should be assessed at least three months postpartum. Future research should also consider the setting in which the sessions are conducted, whether sessions should be conducted with the woman alone or include her partner, whether group sessions should be used, the number of sessions to be conducted and the time interval between sessions, and the acceptability of different types of practitioners providing the debriefing.

Bibliographic details

Gamble J A, Creedy D K, Webster J, Moyle W. A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery 2002; 18(1): 72-79. [PubMed: 11945055]

Other publications of related interest

Mitchell J, Dyregrov A. Traumatic stress in disaster workers and emergency personnel. Prevention and intervention handbook of traumatic stress syndromes. In: Wilson JP, Raphael B, editors. International handbook of traumatic stress syndromes. New York: Plenum Press; 1993.

Indexing Status

Subject indexing assigned by NLM

MeSH

Adaptation, Psychological; Counseling /standards; Crisis Intervention /methods; Depression, Postpartum /prevention & control /psychology; Female; Humans; Infant, Newborn; Maternal Welfare; Mothers /psychology; Postnatal Care /standards; Pregnancy; Stress, Psychological /prevention & control /psychology

AccessionNumber

12002004010

Database entry date

29/02/2004

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.