IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression Joan Webster * , John Linnane, Janice Roberts, Susan Starrenburg, Janis Hinson, Linda Dibley Objective To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression. Design A randomised controlled trial. Setting A large metropolitan obstetric hospital. Population or sample Pregnant women with risk factors for postnatal depression. Methods Women attending their first prenatal visit at the Royal Women’s Hospital, Brisbane, were screened for risk factors for postnatal depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression (Educate); and a letter to the woman’s referring general practitioner and local Child Health Nurse, alerting them of the woman’s risk for postnatal depression (Alert). Main outcome measure Edinburgh Postnatal Depression Scale Score > 12 at 16 weeks postpartum. Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of >12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50–1.28). Conclusion Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful. INTRODUCTION Postnatal depression continues to be a focus of clinical and research interest 1–3 . This is partly because the con- dition is so widespread, affecting between 10% and 15% of women following childbirth 4 , and partly because evidence shows poor behavioural and cognitive outcomes for infants of women with postnatal depression 5 . Diagnosing postnatal depression is problematic because women often fail to report symptoms to their doctor or child health nurse and, in turn, health professionals may fail to ask appropriate questions in the postnatal period, which could assist with the diagnosis 6,7 . There is a general agreement that the aetiology of postnatal depression is multifaceted and the literature is now reasonably clear about which prenatal factors are associated with the condition. Family or personal histories of mental illness, poor social support and partnership problems have been consistently implicated. Using these risk factors, a number of attempts have been made to identify an ‘at risk’ group to test prenatal interventions aimed at reducing the incidence of postnatal depression 8,9 . Such attempts have been largely unsuccessful, primarily because they have targeted the intervention at prenatal education classes, where poor attendance of those at risk is common. One way around this is to include any inter- vention as part of individualised prenatal care. The purpose of the present study was to test a new intervention, based on strategies that may be easily incor- porated into routine prenatal care. METHODS After Institutional Ethics Committee approval, women were recruited during their booking visit at the public prenatal clinic at the Royal Women’s Hospital, Brisbane between February 1997 and September 1997. In the IDentify component of the strategy, women were screened for the presence of any of the following risk factors for postnatal depression: (1) low social or partner support, measured by a score of 24 or less on the Maternity Social BJOG: an International Journal of Obstetrics and Gynaecology September 2003, Vol. 110, pp. 842–846 D RCOG 2003 BJOG: an International Journal of Obstetrics and Gynaecology PII:S1470-0328(03)02977-X www.bjog-elsevier.com Royal Women’s Hospital, Australia * Correspondence: J. Webster, Level 6, Ned Hanlon Building, Royal Women’s Hospital, Butterfield Street, Herston 4029, Australia.