BMJ 2002;324:1062 ( 4 May )

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Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood

H Hiscock, paediatrician,  M Wake, director. 

Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia, 3052

Correspondence to: H Hiscock hiscockh{at}cryptic.rch.unimelb.edu.au

Objective: To compare the effect of a behavioural sleep intervention with written information about normal sleep on infant sleep problems and maternal depression.
Design: Randomised controlled trial.
Setting: Well child clinics, Melbourne, Australia
Participants: 156 mothers of infants aged 6-12 months with severe sleep problems according to the parents.
Main outcome measures: Maternal report of infant sleep problem; scores on Edinburgh postnatal depression scale at two and four months.
Intervention: Discussion on behavioural infant sleep intervention (controlled crying) delivered over three consultations.
Results: At two months more sleep problems had resolved in the intervention group than in the control group (53/76 v 36/76, P=0.005). Overall depression scores fell further in the intervention group than in the control group (mean change 3.7, 95% confidence interval 4.7 to 2.7, v 2.5, 1.7 to 3.4, P=0.06). For the subgroup of mothers with depression scores of 10 and over more sleep problems had resolved in the intervention group than in the control group (26/33 v 13/33, P=0.001). In this subgroup depression scores also fell further for intervention mothers than control mothers at two months (6.0, 7.5 to 4.0, v 3.7, 4.9 to 2.6, P=0.01) and at four months (6.5, 7.9 to 5.1 v -4.2, -5.9 to 2.5, P=0.04). By four months, changes in sleep problems and depression scores were similar.
Conclusions: Behavioural intervention significantly reduces infant sleep problems at two but not four months. Maternal report of symptoms of depression decreased significantly at two months, and this was sustained at four months for mothers with high depression scores.

What is already known on this topic Infant sleep problems and postnatal depression are both common potentially serious problems Women whose infants have sleep problems are more likely to report symptoms of depression Uncontrolled studies in clinical populations suggest that reducing infant sleep problems improves postnatal depression, but there is no good quality evidence in the community for such effectiveness What this study adds A brief community based sleep intervention based on teaching the controlled crying method effectively decreased infant sleep problems and symptoms of maternal depression, particularly for "depressed" mothers The intervention was acceptable to mothers and reduced the need for other sources of help

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