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

Discussion

The findings of our study highlight the experiences and acceptability of a culturally-adapted intervention (PHP) by British South Asian women. The main reasons for participants to engage and participate in the PHP were to gain support and to improve their self esteem and well-being. These findings are in line with the Villegas & McKay[30] study where low self-esteem has been reported as a risk factor for developing postnatal depression. The perception of the group as a way of getting social support by most of the participants is consistent with the findings from a US-based study reporting women who continued to be depressed two years after giving birth as more likely to lack social support.[31]

The participants in our study reported feeling positive after the PHP intervention, although some faced barriers from the family. A key factor in retaining women in the PHP intervention was engaging with their family members, which facilitated their attendance at the sessions. A study with Pakistani women with postnatal depression living in Pakistan[32] reported that the intervention, while focusing on the mother and the infant, should also involve other members of the family for the mother to receive continued support so that she is able to engage with the intervention. An earlier study with British Pakistani women[10] reported that a major hindrance to social group participation was resistance from family members, particularly husbands.

A factor that helped with participation was the availability of free childcare to the participants at the intervention venue. In addition, some of the participants had older children; therefore, intervention sessions took place during term times. The Reay et al.[33] pilot study of group interpersonal psychotherapy for postnatal depression and research in the US[34] consider these to be key factors in improving engagement, particularly with hard-to-reach communities. Addressing transport arrangements was also reported to be an important factor in this study. The findings are also supported by Crockett et al.'s[35] study where lack of transport was found to be a barrier and women reported facing obstacles in getting transportation to the sessions. Chaudhry et al.[11] and later Gater et al.[17] also reported that provision of transport was an absolute necessity to ensure attendance to the intervention sessions by participants.

Furthermore, other difficulties raised by some participants were the inability to read and understand handouts written in English and the carrying out of between-session work due to personal and domestic commitments. There were, therefore, suggestions to add material in Urdu along with English, and some participants reported that completing the between-session work at home was not always a practical option for them due to time constraints. This needs to be considered in future research.

All the participants experienced an overall positive change in their attitudes, behaviours, and confidence. This positive change was attributed to a combination of facilitator input and coping strategies acquired over the 12 weekly sessions. The role of the facilitator was appreciated highly and the participants found the facilitator to be culturally aware and appropriately trained. The facilitator was open and communicative and this enhanced the overall process and led to increased positivity in the participants. Rahman[32] states that an understanding of the sociocultural context is essential for culturally-adapted interventions. In Rahman's[32] study the community health workers were from the same community as the women, and understood the sociocultural context of the women's problems which was found to improve engagement.

Because the PHP intervention was group-based, all the participants found factors such as sharing information, relating problems with each other, and gaining from the experiences of others helpful, and these contributed to their overall positive feelings. This is similar to the findings of Chaudhry et al.[14] and Gater et al..[10] Some of the participants highlighted the need for some individual sessions along with the group sessions. They felt the need to talk about private matters to the facilitator on a one-to-one basis.

The impact of the PHP intervention was reflected in an overall positive change in participants' dealing with family members and children. Particularly participants reported feeling calmer and much more relaxed when dealing with their children.

Strengths and Limitations of the Study

A major strength of this study is the recruitment of participants from a hard-to-reach British South Asian community—Pakistani, Bangladeshi, and Indian women. An additional strength is the ability to engage depressed women during the postnatal period for up to 6 months, for follow-up assessments, and for interviews. Another strength of the study is the use of bilingual researchers which allowed participants to complete the interviews in their preferred language. This is one of very few studies looking at the overall process of development and implementation of culturally-specific psychological interventions for British South Asian women.

This study took place in the North West region of England; therefore, these results may not be generalizable to other regions in the UK. Most of the participants were of first-generation South Asian origin living in England. These participants were generally isolated and faced additional social pressures. Another limitation of this study is the lack of availability of information from mothers who dropped out and did not attend any of the sessions. This information would have contributed to a deeper understanding of the acceptability of PHP intervention. Further limitation of this study is the conservative definition of completers which was 4 or more sessions out of 12 sessions. This is a conservative value because the mean number of sessions was 6. Another limitation of the study is the lack of inquiry into the impact of intimate partner or other forms of family violence on postnatal mental health problems among the participants. The intervention appears not to have focused on empowerment or other rights-based strategies. Since some of the quotes by the participants suggest coercion and control, further studies are required to gain a clearer understanding of these challenges.

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