Caution must therefore be exercised in interpreting results , but the case for investment in parenting and health visitor-related programmes appears most strong , especially when impacts beyond the health sector are taken into account .
In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects ( largely in the USA ) was reported , while group-based exercise and psychosocial interventions are of potential benefit to older people .
Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial.
OBJECTIVES To investigate outcomes for postnatal women attributed to special training for health visitors ( HVs )  in systematic ally identifying postnatal depression and delivering psychologically informed interventions , and to establish the cost-effectiveness of the intervention . DESIGN A pragmatic r and omised cluster trial with clusters allocated to experimental HV training arms or control , with an 18-month follow-up . SETTING GP practice s in the former Trent Regional Health Authority . PARTICIPANTS Women registered with participating GP practice s who became 36 weeks pregnant during the recruitment phase of the trial , had a live baby and were on a collaborating HV 's caseload for 4 months postnatally . INTERVENTION HV training in the assessment of postnatal women , combined with either cognitive behavioural approach ( CBA ) or person-centred approach ( PCA ) sessions for eligible women , plus the option of a selective serotonin reuptake inhibitor if indicated . MAIN OUTCOME MEASURES The primary outcome was the proportion of at-risk women with a 6-month Edinburgh Postnatal Depression Scale ( EPDS ) score > or = 12 . The primary comparison was between at-risk women in the combined clusters r and omised to HV training and women in practice s r and omised to provide HV usual care . The secondary comparison was to determine any differences between the proportions of women with a 6-month EPDS score > or = 12 in the CBA and PCA groups . RESULTS HVs in 101 clusters in 29 primary care trusts collaborated in the study . From 7649 eligible women 4084 ( 53.4 % ) consented to take part : 17.3 % ( 595/3449 ) of women who returned a 6-week question naire had a 6-week EPDS score > or = 12 and were at-risk women ; 70.3 % ( 418/595 ) of at-risk women had a 6-month EPDS score available . In total , 45.6 % ( 67/147 ) of control group ( CG ) at-risk women had a 6-month EPDS score > or = 12 versus 33.9 % ( 93/271 ) of intervention group ( IG ) women ( p = 0.036 ) . A total of 32.9 % ( 46/140 ) of at-risk women in the CBA group versus 35.1 % ( 46/131 ) in the PCA group had a 6-month EPDS score > or = 12 ( p = 0.74 ) . The CG mean 6-month EPDS score for at-risk women was 11.3 ( SD 5.8 ) versus 9.2 ( SD 5.4 ) for the IG ( p = 0.002 ) and this remained statistically significant after adjusting for 6-week variables ( p = 0.001 ) . In total , 16.4 % ( 150/914 ) of all women in the CG had a 6-month EPDS score > or = 12 compared with 11.7 % ( 205/1745 ) in the IG ( p = 0.003 ) . The CG mean 6-month EPDS score for all women was 6.4 ( SD 5.2 ) compared with 5.5 ( SD 4.7 ) for the IG ( p < 0.001 ) . The economic analysis results showed a consistent pattern of psychological approaches being cost-effective at funding levels used by the National Institute for Health and Clinical Excellence . CONCLUSIONS HV training was effective compared with HV usual care in reducing the proportion of at-risk women with a 6-month EPDS score > or = 12 , with a wide confidence interval for the estimated intervention effect , suggesting that the true treatment effect may be small . The effect remained for 1 year . The economic evaluation demonstrated that the HV intervention was highly likely to be cost-effective compared with the control . There was no difference in outcomes between the CBA and the PCA groups
Caution must therefore be exercised in interpreting results , but the case for investment in parenting and health visitor-related programmes appears most strong , especially when impacts beyond the health sector are taken into account .
In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects ( largely in the USA ) was reported , while group-based exercise and psychosocial interventions are of potential benefit to older people .