Depression in the work of British health visitors: Clinical facets

The primary health care setting has been established as a key venue for identifying and working with depression. Despite this, and the high risk of depression experienced by women in the post-natal period, maternal depression has been little examined in the work of health visitors. This study focuses on clinical facets of this work, including the rate and content of depression amongst health visitor attenders, the capacity of health visitors to identify accurately the presence of depression, the relationship between depression and child abuse and child behavioural issues, variations in the practice of health visitors and work with other professionals. In a cohort of 701, 11% of women were depressed, with distinguishing symptoms including fatigability, disgust/hate of herself and a sense of failure. Health visitors were not generally accurate in their identification of depression, were significantly more likely to see depressed women at home (than at clinic), but there was little difference in mean frequency of consultations according to whether or not the women were depressed. Urban health visitors had a higher mean frequency of consultations, but rural health visitors showed a rather greater tendency to increase frequency of consultation with the presence of depression. Child abuse concerns and behavioural problems were significantly associated with depression and these were three times as frequent amongst depressed women with no children aged under one compared with women in their post-natal year. Depressed women were far more likely to be involved with other agencies, but the GP was by far the most likely other professional to be involved. Health visitors are in a strategic position to help women with depression, and it is important that they are able to identify its presence. The association with child abuse is very important and indicates the need for multi-professional involvement, particularly with social workers, to a greater degree than was evident. The higher rate of depression in women beyond the post-natal year, was a surprising finding, and particularly in view of its relationship with child abuse concerns, suggests that this is a group of attenders who should be carefully monitored.