Oye Gureje1, Bibilola D Oladeji2, Alan A Montgomery3, Ricardo Araya4, Toyin Bello5, Dan Chisholm6, Danielle Groleau7, Laurence J Kirmayer8, Lola Kola9, Lydia B Olley10, Wei Tan11, Phyllis Zelkowitz12. 1. Professor of Psychiatry, Director, World Health Organization Collaborating Center for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria. 2. Senior Lecturer, Consultant Psychiatrist, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria. 3. Professor of Medical Statistics and Clinical Trials, Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, UK. 4. Director, Centre for Global Mental Health, Department of Health Services and Population Research, King's College London, UK. 5. Biostatistician, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria. 6. Programme Manager, Division of Noncommunicable Diseases, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland. 7. Associate Professor, Senior Investigator, Division of Social and Transcultural Psychiatry, McGill University; and Director, Department of Psychiatry, Jewish General Hospital, Canada. 8. Professor, Director, Division of Social and Transcultural Psychiatry, McGill University; and Department of Psychiatry, Jewish General Hospital, Canada. 9. Medical Sociologist, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria. 10. Project Coordinator, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria. 11. Medical Statistician, Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, UK. 12. Associate Professor, Division of Social and Transcultural Psychiatry, McGill University; and Research Director, Department of Psychiatry, Jewish General Hospital, Canada.
Abstract
BACKGROUND: Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. AIM: To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. METHOD: Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme - Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). RESULTS:There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 70% with HIT and 66% with LIT: risk difference 4% (95% CI -4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. CONCLUSIONS: Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care. DECLARATION OF INTERESTS: None.
RCT Entities:
BACKGROUND: Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. AIM: To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. METHOD: Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme - Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). RESULTS: There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 70% with HIT and 66% with LIT: risk difference 4% (95% CI -4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. CONCLUSIONS: Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care. DECLARATION OF INTERESTS: None.
Authors: Bradley H Wagenaar; Wilson H Hammett; Courtney Jackson; Dana L Atkins; Jennifer M Belus; Christopher G Kemp Journal: Glob Ment Health (Camb) Date: 2020-03-02