Gender-informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: cluster randomised controlled trial

Abstract

Objectives Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. Design Cluster-randomised controlled trial. Setting 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). Participants English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. Intervention WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. Main outcome measures Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. Results In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. Conclusions WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare. Trial registration number ACTRN12613000506796; Results.

Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness ofWhat Were We Thinking

“…The outcome models included baseline EQ-5D-3L score to account for baseline HRQoL, plus other factors which might influence quality of life: perceived quality of the intimate partner relationship and level of support, and a measure of adverse life events (for further details regarding measures used in the study, see ref. 29). Analyses were performed in STATA V.13 using a generalised linear regression model (GLM) for cost, to allow for the non-normal distribution of costs without requiring transformation of the cost variable,43 a linear regression model for QALYs and a logit model for the binary clinical outcome (presence or absence of depression, anxiety and adjustment disorders).…”

“…The specifications of the GLM model for costs were informed by a modified Parks test, resulting in a log link and gamma family,43 while the distribution of QALYs fitted with the assumption of normality in the linear regression model. Since these regression models included different explanatory variables than those included in the clinical evaluation,29 the results may differ slightly. Cluster-robust SEs were used to account for randomisation at the level of the MCHC, rather than the individual.…”

“…The protocols for the clinical study14 and economic evaluation28 have been published previously, as have the trial results 29. This paper presents the results of a CEA and a CUA, and discusses the implications of these results for decision-makers seeking cost-effective interventions for the prevention of postnatal mental health problems.…”

Brief Evidence-Based Interventions for Universal Child Health Services: a restricted evidence assessment of the literature

“…Five studies focused on home learning environment and reported on no other outcome areas [48][49][50][51][52]. Four studies focused on parental mental health and reported on no other outcome areas [53][54][55][56][57].…”

Parenting the crying infant

“…Box 1 lists website addresses for parent support programmes in Australia, Canada and North America, and the UK and others are under development [57]. Trials of their value and cost-effectiveness are underway [58,59]. It is too early to say whether or not they will fulfil their promise, but early findings give some cause for optimism [60,61].…”