Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial

doi:10.1136/bmj.a3064

Published 15 January 2009, doi:10.1136/bmj.a3064
Cite this as: BMJ 2009;338:a3064

Research

Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial

C-L Dennis, associate professor and Canada research chair in perinatal community health¹^,2, E Hodnett, professor and Heather M Reisman chair in perinatal nursing research¹, L Kenton, trial coordinator¹, J Weston, senior trial coordinator¹, J Zupancic, assistant professor of paediatrics³, D E Stewart, university professor and Lillian Love chair in women’s health², A Kiss, biostatistician⁴

¹ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, ² Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada, ³ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, ⁴ Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada

Correspondence to: C-L Dennis cindylee.dennis{at}utoronto.ca

Objective To evaluate the effectiveness of telephone based peersupport in the prevention of postnatal depression.

Design Multisite randomised controlled trial.

Setting Seven health regions across Ontario, Canada.

Participants 701 women in the first two weeks postpartum identifiedas high risk for postnatal depression with the Edinburgh postnataldepression scale and randomised with an internet based randomisationservice.

Intervention Proactive individualised telephone based peer (motherto mother) support, initiated within 48-72 hours of randomisation,provided by a volunteer recruited from the community who hadpreviously experienced and recovered from self reported postnataldepression and attended a four hour training session.

Main outcome measures Edinburgh postnatal depression scale,structured clinical interview-depression, state-trait anxietyinventory, UCLA loneliness scale, and use of health services.

Results After web based screening of 21 470 women, 701 (72%)eligible mothers were recruited. A blinded research nurse followedup more than 85% by telephone, including 613 at 12 weeks and600 at 24 weeks postpartum. At 12 weeks, 14% (40/297) of womenin the intervention group and 25% (78/315) in the control grouphad an Edinburgh postnatal depression scale score >12 ( ${chi}$ ²=12.5,P<0.001; number need to treat 8.8, 95% confidence interval5.9 to 19.6; relative risk reduction 0.46, 95% confidence interval0.24 to 0.62). There was a positive trend in favour of the interventiongroup for maternal anxiety but not loneliness or use of healthservices. For ethical reasons, participants identified withclinical depression at 12 weeks were referred for treatment,resulting in no differences between groups at 24 weeks. Of the221 women in the intervention group who received and evaluatedtheir experience of peer support, over 80% were satisfied andwould recommend this support to a friend.

Conclusion Telephone based peer support can be effective inpreventing postnatal depression among women at high risk.

Trial registration ISRCTN 68337727.

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Rapid Responses:

Read all Rapid Responses

Nothing New: joyce a venis
bmj.com, 26 Jan 2009 [Full text]
Trial design undermines conclusions: Michael King, et al.
bmj.com, 31 Jan 2009 [Full text]
There is more to it!: David R Musa
bmj.com, 1 Feb 2009 [Full text]