2
|
Husain N, Lunat F, Lovell K, Miah J, Chew-Graham CA, Bee P, Waqas A, Pierce M, Sharma D, Atif N, Aseem S, Bhui K, Bower P, Brugha T, Chaudhry N, Ullah A, Davies L, Gire N, Kai J, Morrison J, Mohmed N, Rathod S, Siddiqi N, Sikander S, Waheed W, Mirza I, Williams C, Zaidi N, Emsley R, Rahman A, Morriss R. Efficacy of a culturally adapted, cognitive behavioural therapy-based intervention for postnatal depression in British south Asian women (ROSHNI-2): a multicentre, randomised controlled trial. Lancet 2024; 404:1430-1443. [PMID: 39396350 DOI: 10.1016/s0140-6736(24)01612-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Postnatal depression necessitates timely and effective interventions to mitigate adverse maternal and child outcomes in the short term and over the life course. British south Asian women with depression are often underserved and undertreated due to stigma, language barriers, and cultural barriers. This trial aimed to test the clinical efficacy of a culturally adapted, group cognitive behavioural therapy (CBT)-based intervention, the Positive Health Programme (PHP), delivered by non-specialist health workers for postnatal depression in British south Asian women. METHODS This study was a randomised controlled trial, with culturally adapted recruitment and an internal pilot, comparing the PHP (intervention group) with treatment as usual (control group) in British south Asian women with postnatal depression. The study was conducted at five centres across the UK. Participants were aged 16 years or older, met the DSM-5 criteria for depression, and had infants aged 0-12 months. Randomisation (1:1) was stratified by centre, with a block size of 18, and was done through an independent remote telephone service. The PHP was delivered over 12 group sessions in 4 months. The primary outcome was recovery from depression (defined as a Hamilton Depression Rating Scale [HDRS] score ≤7) at 4 months after randomisation, and an assessment was also done at 12 months. Analysis was on an intention-to-treat basis including only participants with non-missing outcome data; we used a random-effects logistic regression model including fixed covariates for study site, baseline depression severity (HDRS score), parity, and years in education and a random coefficient for therapy group. This trial is registered with the ISRCTN (ISRCTN10697380). FINDINGS Of the 9136 individuals approached for recruitment between Feb 8, 2017, and March 29, 2020, 4296 women were eligible for and consented to screening, among whom 732 screened positive and were randomly allocated: 368 (50%) to the PHP group and 364 (50%) to the control group. Participants were mostly of Pakistani (397 [55%] of 719 with available data), Indian (176 [24%]), or Bangladeshi ethnicity (127 [18%]), with an overall mean age of 31·4 years (SD 5·2), with their youngest infants having a mean age of 23·6 weeks (14·2). At 4 months from randomisation, the proportion of participants who showed recovery from depression on the HDRS was significantly higher in the PHP group (138 [49%] of 281) than in the control group (105 [37%] of 281; adjusted odds ratio 1·97 [95% CI 1·26-3·10]). At the 12-month follow-up, this difference was no longer significant (1·02 [95% CI 0·62-1·66]). INTERPRETATION In British south Asian women with postnatal depression, a culturally adapted group CBT-based intervention could aid in quicker recovery from depression compared with treatment as usual. Further research is needed to identify how to sustain the treatment effect and establish strategies for scale-up. FUNDING UK National Institute for Health and Care Research.
Collapse
Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Mersey Care NHS Foundation Trust, Liverpool, UK.
| | - Farah Lunat
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jahanara Miah
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Carolyn A Chew-Graham
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK; School of Medicine, Keele University, Newcastle-under-Lyme, UK; Primary Care Mental Health, Midlands Partnership Foundation Trust, Stafford, UK; Department of Health Sciences, University of York, York, UK; NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Ahmed Waqas
- Mersey Care NHS Foundation Trust, Liverpool, UK; Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Matthias Pierce
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Deepali Sharma
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Najia Atif
- Perinatal Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Saadia Aseem
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kamaldeep Bhui
- Department of Psychiatry & Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Traolach Brugha
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning (PILL), Karachi, Pakistan; Dow University of Health Sciences, Karachi, Pakistan
| | - Akbar Ullah
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Linda Davies
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Nadeem Gire
- Manchester Global Foundation, Manchester, UK; University of Bolton, Bolton, UK
| | - Joe Kai
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Jillian Morrison
- General Practice, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naeem Mohmed
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Innovation Department, Faculty of Science, University of Portsmouth, Portsmouth, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Siham Sikander
- Mersey Care NHS Foundation Trust, Liverpool, UK; Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK
| | - Waquas Waheed
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Ilyas Mirza
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Christopher Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Five Areas, Clydebank, UK
| | - Nosheen Zaidi
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
3
|
Husain N, Lunat F, Lovell K, Sharma D, Zaidi N, Bokhari A, Syed A, Tomenson B, Islam A, Chaudhry N, Waheed W. Exploratory RCT of a group psychological intervention for postnatal depression in British mothers of South Asian origin - ROSHNI-D. Acta Psychol (Amst) 2023; 238:103974. [PMID: 37413896 PMCID: PMC10415672 DOI: 10.1016/j.actpsy.2023.103974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a global public health problem. There is a high prevalence of PND amongst ethnic minority women and major ethnic inequalities in mental health care in the U.K. Language and cultural barriers pose a significant challenge for access to timely treatment and interventions for British South Asian (BSA) women with PND. METHODS The study, carried out in Manchester and Lancashire, England, was a two-arm single-blind exploratory randomised controlled trial. BSA women (N = 83) having a baby <12 months were randomised either to the group receiving the culturally adapted Positive Health Programme (PHP) (n = 42) or to the group receiving treatment as usual (TAU) (n = 41). Follow-up assessments were at 3 months (end of intervention) and 6 months after randomisation. RESULTS Using an intention to treat analysis, there was no significant difference between PHP intervention and TAU groups in depression measured using Hamilton Depression Rating Scale both at 3 and 6 months follow up. Using modified intention to treat analysis, women who attended four or more sessions showed significant reduction in depression in the PHP group compared to the TAU group and the greater number of sessions attended was associated with greater reductions in depression scores. LIMITATIONS The sample was relatively small and the study was conducted in one geographical area in Northwest England; hence, these results may not be generalizable to other regions and populations. CONCLUSION The recruitment and trial retention figures highlighted the ability of the research team to engage with BSA women, having implications in planning services for this group. TRIAL REGISTRATION Clinicaltrials.govNCT01838889.
Collapse
Affiliation(s)
- Nusrat Husain
- The University of Manchester, Jean Mcfarlane Building, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Farah Lunat
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Lantern Centre, Vicarage Lane, Fulwood PR2 5NT, United Kingdom.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Deepali Sharma
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Nosheen Zaidi
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Asad Bokhari
- Cheetamhill Medical Centre, 244 Cheetham Hill Rd, Cheetham Hill, Manchester M8 8UP, United Kingdom
| | - Aleena Syed
- University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Barbara Tomenson
- School of Health Sciences, The University of Manchester, Jean Mcfarlane Building, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Anharul Islam
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Dow University of Health Sciences, Pakistan
| | - Waquas Waheed
- Centre for Primary Care and Health Services Research, Williamson Building, The University of Manchester, M13 9PL, United Kingdom
| |
Collapse
|