Effect of peer support on prevention of postnatal depression among high risk women: Multisite randomized controlled trial

Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
BMJ (online) (Impact Factor: 17.45). 01/2009; 338(jan15 2):a3064. DOI: 10.1136/bmj.a3064
Source: PubMed


To evaluate the effectiveness of telephone based peer support in the prevention of postnatal depression.
Multisite randomised controlled trial.
Seven health regions across Ontario, Canada.
701 women in the first two weeks postpartum identified as high risk for postnatal depression with the Edinburgh postnatal depression scale and randomised with an internet based randomisation service.
Proactive individualised telephone based peer (mother to mother) support, initiated within 48-72 hours of randomisation, provided by a volunteer recruited from the community who had previously experienced and recovered from self reported postnatal depression and attended a four hour training session.
Edinburgh postnatal depression scale, structured clinical interview-depression, state-trait anxiety inventory, UCLA loneliness scale, and use of health services.
After web based screening of 21 470 women, 701 (72%) eligible mothers were recruited. A blinded research nurse followed up more than 85% by telephone, including 613 at 12 weeks and 600 at 24 weeks postpartum. At 12 weeks, 14% (40/297) of women in the intervention group and 25% (78/315) in the control group had an Edinburgh postnatal depression scale score >12 (chi(2)=12.5, P<0.001; number need to treat 8.8, 95% confidence interval 5.9 to 19.6; relative risk reduction 0.46, 95% confidence interval 0.24 to 0.62). There was a positive trend in favour of the intervention group for maternal anxiety but not loneliness or use of health services. For ethical reasons, participants identified with clinical depression at 12 weeks were referred for treatment, resulting in no differences between groups at 24 weeks. Of the 221 women in the intervention group who received and evaluated their experience of peer support, over 80% were satisfied and would recommend this support to a friend.
Telephone based peer support can be effective in preventing postnatal depression among women at high risk.
ISRCTN 68337727.

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Available from: Julie Weston, Dec 28, 2013
    • "Sometimes, a complex intervention may have effects in many domains and a single primary and a few secondary outcomes do not provide adequate evaluation (Craig et al., 2008). When exploring parenting or the transition to parenthood, the outcome measured is more difficult to determine than when aiming to increase breastfeeding rates (Kaunonen et al., 2012), for example, or decrease depression (Dennis et al., 2009). The other potential, and more probable, explanation might be the lack of randomised controlled studies in the area reviewed. "
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    • "This program was provided within the context of a randomized controlled trial designed to evaluate the effectiveness of preventing PPD. Consequently, while all mothers in the study had access to the standard community postpartum services, mothers who were randomly allocated to the peer support group also received telephone-based support from a peer volunteer [25]. Of the 349 mothers randomized to the peer support group in the trial, the majority were married (n = 323, 93%) and had some postsecondary education (n = 279, 79.9%); 40.7% (n = 142) were multiparous and 20.6% (n = 72) self-reported their nationality as non-Canadian. "
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    ABSTRACT: A randomized controlled trial evaluated the effect of telephone-based peer support on preventing postpartum depression (PPD) among high-risk mothers. The results indicated that support provided by peer volunteers may be an effective preventative strategy. The purpose of this paper is to outline the process of developing, implementing, maintaining, and evaluating the peer support program that we used in this PPD prevention trial. The peer support program had been used successfully in a pilot trial and a previous breastfeeding peer support trial. Based on our experience and lessons learned, we developed a 4-phase, 12-step approach so that the peer support model could be copied and used by different health providers in various settings. We will use the PPD prevention trial to demonstrate the suggested steps. The trial aim to prevent the onset of PPD was established. Peer volunteers who previously experienced and recovered from self-reported PPD were recruited and attended a four-hour training session. Volunteers were screened and those identified as appropriate to provide support to postpartum mothers were selected. Women who scored more than 9 on the Edinburgh Postnatal Depression Scale within the first two weeks after childbirth were recruited to participate in the trial and proactive, individualized, telephone-based peer support (mother-to-mother) was provided to those randomized to the intervention group. Peer volunteers maintained the intervention, supported other volunteers, and evaluated the telephone-based support program. Possible negative effects of the intervention were assessed. An in-depth assessment of maternal perspectives of the program at 12 weeks postpartum was performed. The 4-phase, 12-step approach delineated in this paper provides clear and concise guidelines for health professionals to follow in creating and implementing community-based, peer-support interventions with the potential to prevent PPD.Trial registration: Current Controlled Trials ISRCTN68337727.
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    • "Several studies have been conducted using the UCLA Loneliness Scale (Dennis et al. 2009; Faith et al. 2008; Ghassemzadeh et al. 2008; Vassar and Crosby 2008). Higher scores on the UCLA Loneliness Scale mean higher levels of loneliness. "
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