Group Psychological Intervention for Postnatal Depression

A Nested Qualitative Study With British South Asian Women

Yumna Masood; Karina Lovell; Farah Lunat; Najia Atif; Waquas Waheed; Atif Rahman; Rahena Mossabir; Nasim Chaudhry; Nusrat Husain

Disclosures

BMC Womens Health. 2015;15(109) 

In This Article

Background

Postnatal depression affects approximately 8.5–11.0 % of all mothers in Western societies.[1,2] The prevalence of perinatal depression is higher among mothers from certain ethnic minority groups.[3] This indicates ethnicity to be a significant risk factor for developing postnatal depression. Ethnicity has also been reported to be linked to poor health outcomes for both ethnic minority mothers and their infants, as reflected in higher rates of infant and maternal mortality and morbidity and lower birth-weight.[4] Part of this risk lies in the interaction of economic disadvantage with ethnic minority grouping.

Postnatal depression is a treatable disorder.[5] Antidepressants are effective, but new mothers are reluctant to take such medications whilst nursing.[6] Among psychotherapeutic interventions, Interpersonal Psychotherapy (IPT) and Cognitive Behavioural Therapy (CBT) have shown the most efficacy in the treatment of postnatal depression.[6–8] With regard to the postnatal treatment of British ethnic minority women, the National Institute of Clinical Excellence (NICE)[9] 2007 guidelines recommend that they should be provided with culturally sensitive information and treatment. However, we know from our earlier work[10,11] that several barriers prevent access to appropriate mental health services for British South Asian women. Even where help is accessible it is not sensitive to the cultural needs of this population.

British South Asian women have higher birth rates compared to the majority white population and are considered 'difficult to reach' due to language and cultural barriers. Research[12,13] indicates that British Pakistani women have high rates of postnatal depression, lack social support, experience interpersonal relationship problems[12] and linguistic and cultural barriers in accessing services.[14] Isolation and lack of social support are therefore important elements to be addressed in interventions. There is, however, little empirical evidence addressing the adaptation of evidence-based interventions to ensure their applicability to specific ethnic communities.[15–18] Recent studies evaluating a culturally-sensitive psychosocial group intervention for the treatment of depression in British Pakistani women reported an improvement in participants' self-confidence at the end of the intervention.[11,19] Overall, the findings indicated that social groups which had taken into consideration the sociocultural needs of British Pakistani women experiencing depression were acceptable to them.

Despite the above research, there is a clear gap in evidence for informing culturally-sensitive interventions for maternal depression in British South Asian women.[18–20] This paper provides a qualitative evaluation of a psychosocial intervention called the Positive Health Programme (PHP), which was adapted for and offered to British South Asian women experiencing postnatal depression. The programme was designed to be delivered to groups of participants using the cognitive behavioural model.[21] The manual assisted programme, tailored to the cultural needs of British Pakistani women, was developed by our group and initially feasibility tested for a PhD project.[22] It consisted of 12 weekly group sessions delivered over 3 months. The manual is organized into 9 distinct sections.

The Main Trial

This paper describes the results of a post-intervention qualitative study as part of an exploratory randomized controlled trial conducted to test the feasibility and acceptability of a culturally-adapted intervention (Positive Health Programme or PHP) for postnatal depression in British South Asian women. The study was carried out across Manchester and Lancashire (UK). The recruitment (N = 615) and trial retention figures (70 %) highlight the ability of the research team to engage with this population. In the intention-to-treat analysis there was no significant difference between intervention and control groups for any of the depression scores at either follow-up. Following the initial analysis, another analysis was carried out based on attendance to the intervention. Completers were defined as those participants who had attended 4 or more sessions. Fifteen of the 42 patients in the intervention group did not attend any of the therapy sessions, while the remaining 27 patients attended at least 4 sessions. Overall, the mean number of sessions attended was 6.6 (SD = 5.2). The Spearman's correlation coefficient between the number of sessions attended and reduction in the Hamilton score from baseline to follow-up 1 was 0.35 (p = 0.048), with greater reductions in the Hamilton score being associated with more sessions attended. Correlations between changes from baseline to follow-ups in the other variables ranged from −0.20 for EPDS at the second follow-up.

This paper describes the qualitative phase of the trial and explores the participants' experiences of receiving the PHP.

Aims

To assess the acceptability and overall experience of the Positive Health Programme by British South Asian mothers.

Objectives

  1. To identify the barriers faced by the British South Asian women in accessing the intervention.

  2. To identify factors which facilitated participants' engagement with the PHP.

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