Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of<i>What Were We Thinking</i>

Ride, Jemimah; Lorgelly, Paula; Tran, Thach; Wynter, Karen; Rowe, Heather; Fisher, Jane

doi:10.1136/bmjopen-2016-012086

Cited by 12 publications

(34 citation statements)

References 52 publications

(45 reference statements)

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“…Thirdly, the EQ-5D questionnaire is relatively easy and quick to apply in comparison to the MGI or MAPP-QOL instruments. In addition, there had been some experience with using the EQ-5D questionnaire to evaluate postpartum QOL, yet mostly from high income countries [ 25 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system

Köhler¹,

Annerstedt²,

Diwan³

et al. 2018

BMC Pregnancy Childbirth

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BackgroundThere has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.MethodsA convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30 days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.ResultsForty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0–3 days postpartum: 0.28 vs. 0.57, 3–7 days postpartum: 0.59 vs. 0.81; P < 0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, pain or discomfort; P ≤ 0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21–30 days postpartum: 0.85 vs. 0.93; P < 0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P = 0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P < 0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.ConclusionsVaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is a suitable instrument to assess postpartum QOL in Indian women.

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Section: Discussionmentioning

confidence: 99%

Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system

Köhler¹,

Annerstedt²,

Diwan³

et al. 2018

BMC Pregnancy Childbirth

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“…A more recent study in Australia suggests that psychoeducation may also be cost-effective in preventing postpartum depression and anxiety. 123…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

Preventive strategies for mental health

Arango

Díaz-Caneja

McGorry

et al. 2018

The Lancet Psychiatry

485

354

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Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.

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“…As shown in table 1 , the earliest and largest number of included studies were from the UK (n=4), 28–31 the most recent two studies were from the USA 32 33 and there was one study from each of Australia 34 and Canada. 35 …”

Section: Resultsmentioning

confidence: 99%

“… 30 33 All studies focused on postnatal depression in mothers, although the study by Ride et al did also consider anxiety in mothers and the mental health of fathers in the perinatal period. 34 Two of the preventative interventions were targeted at distinct groups: high risk women 29 ; first time mothers. 34 One intervention involved lay or peer support, 35 two were delivered by health visitors 29 30 and the remainder were delivered across a range of settings/healthcare professionals/structures including collaborative care 32 33 and group cognitive behavioural therapy (gCBT).…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review

Camacho

Shields

2018

BMJ Open

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ObjectivesAnxiety and/or depression during pregnancy or year after childbirth is the most common complication of childbearing. Economic evaluations of interventions for the prevention or treatment of perinatal anxiety and/or depression (PAD) were systematically reviewed with the aim of guiding researchers and commissioners of perinatal mental health services towards potentially cost-effective strategies.MethodsElectronic searches were conducted on the MEDLINE, PsycINFO and NHS Economic Evaluation and Health Technology Assessment databases in September 2017 to identify relevant economic evaluations published since January 2000. Two stages of screening were used with prespecified inclusion/exclusion criteria. A data extraction form was designed prior to the literature search to capture key data. A published checklist was used to assess the quality of publications identified.ResultsOf the 168 non-duplicate citations identified, 8 studies met the inclusion criteria for the review; all but one focussing solely on postnatal depression in mothers. Interventions included prevention (3/8), treatment (3/8) or identification plus treatment (2/8). Two interventions were likely to be cost-effective, both incorporated identification plus treatment. Where the cost per quality-adjusted life year (QALY) gained was reported, interventions ranged from being dominant (cheaper and more effective than usual care) to costing £39 875/QALY.ConclusionsUncertainty and heterogeneity across studies in terms of setting and design make it difficult to make direct comparisons or draw strong conclusions. However, the two interventions incorporating identification plus treatment of perinatal depression were both likely to be cost-effective. Many gaps were identified in the economic evidence, such as the cost-effectiveness of interventions for perinatal anxiety, antenatal depression or interventions for fathers.PROSPERO registration numberCRD42016051133.

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

Cited by 12 publications

References 52 publications

Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system

Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system

Preventive strategies for mental health

Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review

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