A Randomized Controlled Trial to Evaluate the Effectiveness of Peer (Mother-to-Mother) Support for the Prevention of Postpartum Depression
Objective: To evaluate the effectiveness of telephone based peer support in the prevention of postpartum depression.
Design: Multisite randomized controlled trial.
Setting: Seven health regions across Ontario, Canada.
Participants: 701 women in the first two weeks following delivery identified as high risk for postpartum depression with the Edinburgh postnatal depression scale and randomised with an internet based randomisation service.
Intervention: 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 postpartum depression and attended a four hour training session.
Main outcome measures: Edinburgh postnatal depression scale, structured clinical interview-depression, state-trait anxiety inventory, UCLA loneliness scale, and use of health services.
Results: After web based screening of 21<thin>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 (χ2=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.
Conclusion: Telephone based peer support can be effective in preventing postpartum depression among women at high risk.
Publications:
Dennis, C-L., Hodnett, E., Kenton, L., Weston, J., Zupancic, J., Stewart, D., & Kiss, A. (2009). The effect of peer support on the prevention of postnatal depression among high-risk women: a multi-site randomized controlled trial. British Medical Journal, 338:a3064, doi: 10.1136/bmj.a3064 (Published 15 January)
Dennis, C-L. (2010). Postpartum depression peer support: Maternal perceptions from a randomized controlled trial. International Journal of Nursing Studies, 47, 560-568. doi: 10.1016/j.ijnurstu.2009.10.015
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