Intended for healthcare professionals


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

BMJ 2009; 338 doi: (Published 16 January 2009) Cite this as: BMJ 2009;338:a3064
  1. C-L Dennis, associate professor and Canada research chair in perinatal community health12,
  2. E Hodnett, professor and Heather M Reisman chair in perinatal nursing research1,
  3. L Kenton, trial coordinator1,
  4. J Weston, senior trial coordinator1,
  5. J Zupancic, assistant professor of paediatrics3,
  6. D E Stewart, university professor and Lillian Love chair in women’s health2,
  7. A Kiss, biostatistician4
  1. 1Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
  2. 2Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
  3. 3Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  4. 4Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada
  1. Correspondence to: C-L Dennis cindylee.dennis{at}
  • Accepted 27 October 2008


Objective To evaluate the effectiveness of telephone based peer support 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 identified as high risk for postnatal 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 postnatal 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 21 470 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 postnatal depression among women at high risk.

Trial registration ISRCTN 68337727.


  • Contributions: C-LD (principal investigator) conceptualised and designed the trial, obtained funding, directed implementation, completed data analysis and interpretation, wrote the draft manuscript, and is guarantor. EH (coinvestigator) assisted in all trial activities including design, funding, implementation, data interpretation, and manuscript preparation. LK (trial coordinator) assisted in all trial implementation procedures including managing the population based screening activities, completing participant recruitment, overseeing intervention implementation and data collection procedures, and performing database management activities. JW (senior trial coordinator) assisted in all trial activities including design, funding, budget management, implementation, database management, data interpretation, and manuscript preparation. JZ (coinvestigator and health economist) assisted in designing the trial economic evaluation, obtaining funding, and data interpretation. DS (coinvestigator and psychiatrist) assisted in trial funding and was available for clinical consultation during implementation. AK (coinvestigator and biostatistician) assisted in trial funding, data analysis, data interpretation, and manuscript preparation. All authors have commented on the manuscript.

  • Funding: This work was supported by the Canadian Institutes of Health Research grant number MCT 66874. This trial was conducted and data analysed with complete independence of the researchers from the Canadian Institutes of Health Research.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the University of Toronto ethics committee and ethical review boards of participating health regions. Informed consent was given by all participants.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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