Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: a randomised controlled trial

Stein, Alan; Netsi, Elena; Lawrence, Peter J.; Granger, Charlotte; Kempton, C; Mg, Craske; Nickless, Alecia; Mollison, Jill; Stewart, Derek A.; Rapa, Elizabeth; West, V A; Scerif, Gaia; Cooper, P. J. M.; Murray, Lynne

doi:10.1016/s2215-0366(18)30006-3

Cited by 90 publications

(120 citation statements)

References 39 publications

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“…Fouth, although there was an effect on mother's severity of depression, no significant difference on baby's weight and height for age was observed. Similar results were found in the original THP study 8 and in other trials 32 and we assume that there may be other potent determinants of these outcomes, notably poverty, 6 which our intervention did not address. Additionally, there were no differences in the proportion of mothers exclusively breastfeeding in the previous 24 hours.…”

Section: Discussionsupporting

confidence: 84%

Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India

Fuhr

Weobong

Lazarus

et al. 2019

The Lancet Psychiatry

100

143

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Background:The Thinking Healthy Programme (THP) is a psychological intervention recommended for the treatment of perinatal depression. We assessed the effectiveness and cost-effectiveness of THP delivered by peers (THPP) in Goa, India. Methods:In this single-blind, individually-randomised controlled trial, we recruited pregnant women aged ≥18 years attending antenatal clinics, who scored ≥10 on the Patient Health Questionnaire (PHQ-9). Participants were randomly allocated (1:1) to THPP plus enhanced usual care (EUC), or to EUC alone in randomly-sized blocks, stratified by area of residence. Allocation was concealed using sequentiallynumbered opaque envelopes. Primary outcomes were severity of depressive symptoms (PHQ-9 score) and remission (PHQ-9 score <5) 6 months post-birth assessed by researchers masked to the treatment allocation. Analyses were by intention to treat, adjusting for covariates defined a priori or that showed imbalance at baseline. The trial is registered with ClinicalTrials.gov (NCT02104232).Findings: 280 women were enrolled between 24th October 2014 and 22nd June 2016 (140 per group). At 6 months, 122 (87%) and 129 (92%) women in the THPP plus EUC, and EUC alone groups, respectively, contributed primary outcome data. There was evidence of higher prevalence of remission at 6 months in the THPP plus EUC versus EUC alone group (n=89 (73%) versus n=77 (60%), respectively; prevalence ratio (PR)=1·21; 95% confidence interval (CI) 1·01 to 1·45, p=0·04), but weaker evidence for lower symptom severity (mean 3·47, standard deviation (SD) 4·49 versus 4·48 (SD=5·11), respectively; standardised mean difference (SMD)=-0·18; 95% CI -0·43 to 0·07, p=0·16).Repeated measures analyses over the duration of the trial (measured at 3 and 6 months post-birth) showed beneficial effects on symptom severity (SMD -0·37, 95% CI -0·88 to -0·24, p=0·01), remission (PR=1·21, 95% CI 1·01 to 1·41, p=0·02), WHO-Disability Assessment Schedule (WHO-DAS) scores (SMD=-0·32, 95% CI -0·76 to -0·21, p=0·02) and Multidimensional Scale of Perceived Social Support (MSPSS) scores (SMD=0·51, 95% CI 0·43 to 1·20, p=0·02). . The incremental societal cost per unit improvement on PHQ-9 was -US$ 29·64 (95% CI-32·88 to -26·41) at 3 months, and -US$93·53 (95% CI -180·21 to -6·84) for the whole duration of the trial, with a 87% likelihood of being costsaving in the study setting. The mean cost of providing THPP was US$ 1·36 per beneficiary (95% CI 1·32 to 1·39). There was no evidence of differences in serious adverse events by group, except stigmatisation was more often reported in the EUC alone (9%) versus the THPP plus EUC group (4%; p=0·08).Interpretation: THPP had a moderate effect on symptom severity and remission from perinatal depression over the 6 month post-natal period. THPP is relatively cheap to deliver and pays for itself through reduced health care, time and productivity costs. Funding: NIMH

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Section: Discussionsupporting

confidence: 84%

Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India

Fuhr

Weobong

Lazarus

et al. 2019

The Lancet Psychiatry

100

143

View full text Add to dashboard Cite

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“…The current findings add to this body of literature and suggest that parental empathy may be a key target for parenting interventions. Parenting behavior in parents with depression can be positively impacted by appropriate intervention [77,78]. Emphasizing empathy for one's own child may be particularly impactful for parents at risk for more negative parenting behaviors such as those with depression or postpartum depression, and might also be beneficial if incorporated into broader programs of treatment.…”

Section: Discussionmentioning

confidence: 99%

Depressive symptoms in parents are associated with reduced empathy toward their young children

2020

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Background While depression is typically associated with reduced levels of empathy, this association differs depending on how empathy is measured. Given the importance of empathy in the parent-child relationship, we sought to examine whether the associations between depression and dispositional empathy would also extend to empathy towards one's own child. Methods Within a non-clinical sample of 150 parents of young children, we examined the associations between self-reported depressive symptoms, dispositional empathic tendencies, and empathy specifically toward their own children, and how these associations might differ based on parent gender. Results Depressive symptoms were related to lower levels of cognitive and affective empathy, and higher levels of empathic distress. Over and above the association with dispositional empathy, depressive symptoms were associated with reduced levels of parents' affective empathy toward their own child. The associations between depressive symptoms and both dispositional and own-child specific empathy varied by parent gender. For fathers, depressive symptoms predicted own-child specific affective empathy, over and above dispositional affective empathy, while for mothers, depressive symptoms predicted own-child specific empathic distress, over and above dispositional empathic distress. Conclusions The current findings provide further indication that caregivers with elevated depression may engage in patterns of thoughts and behaviors that have implications for their interactions with their children. Parents' experienced empathy toward their own child may be one mechanism by which depression impacts the early caregiving environment, and thus may be an important target for intervention in improving the early caregiving experiences for children at PLOS ONE

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“…5 Patients discussed, and with practice nurses or healthcare assistants agreed, goals to lower cardiovascular disease risk, such as adhering to statins, improving diet or physical activity levels, reducing alcohol, or quitting smoking. 4 In Osborn and colleagues' cluster randomised trial, 4 done in 76 rural and urban general practices in England with 327 patients, the primary outcome, total cholesterol concentration, decreased in both treatment groups at 12 months (-0·22 mmol/L [SD 1·1] for Primrose vs -0·36 mmol/L [1·1] for treatment as usual). However, mean total cholesterol did not differ between the groups (5·4 mmol/L [SD 1·1] for Primrose vs 5·5 mmol/L [1·1] for treatment as usual; mean difference estimate 0·03, 95% CI -0·22 to 0·29; p=0·788).…”

Section: Managing Cardiovascular Disease Risk In Patients With Severementioning

confidence: 99%

Effective treatment of postnatal depression is associated with normal child development

Howard

Challacombe

2018

The Lancet Psychiatry

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Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: a randomised controlled trial

Abstract: Wellcome Trust.

Cited by 90 publications

References 39 publications

Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India

Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India

Depressive symptoms in parents are associated with reduced empathy toward their young children

Effective treatment of postnatal depression is associated with normal child development

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