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Cited by 27Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcarePersonality Disorders and Psychopathology

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

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Husain, Nusrat, Lunat, Farah, Lovell, Karina, Miah, Jahanara, Chew-Graham, Carolyn A., Bee, Penny, Waqas, Ahmed, Pierce, Matthias +23 more·2024·The Lancet
DOI 10.1016/s0140-6736(24)01612-x
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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.

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References 40 · Cited by 27

Research works printed but not linked: 31

  1. Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in lowincome and middleincome countries. Lancet Psychiatry 2016; 3: 973-82.
  2. Rokicki S, McGovern M, Von Jaglinsky A, Reichman NE. Depression in the postpartum year and life course economic trajectories. Am J Prev Med 2022; 62: 165-73.
  3. Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS CoV2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107.
  4. Knight M, Bunch K, Tuffnell D. Saving lives, improving mothers' care-lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2016-18. Oxford: National Perinatal Epidemiology Unit, 2020.
  5. Watson H, Harrop D, Walton E, Young A, Soltani H. A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe. PLoS One 2019; 14: e0210587. 16 Public Health England. Early years high impact area 2: supporting maternal and family mental health. May 19, 2021. https://www.gov. uk/government/publications/commissioningofpublichealth servicesforchildren/earlyyearshighimpactarea2supporting maternalandfamilymentalhealth https://www.nice.org.uk/ guidance/cg192 (accessed Sept 18, 2024).
  6. Khan S, Lovell K, Lunat F, et al. Culturallyadapted cognitive behavioural therapy based intervention for maternal depression: a mixedmethods feasibility study. BMC Womens Health 2019; 19: 21.
  7. Masood Y, Lovell K, Lunat F, et al. Group psychological intervention for postnatal depression: a nested qualitative study with British south Asian women. BMC Womens Health 2015; 15: 109.
  8. Prady SL, Pickett KE, Petherick ES, et al. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data. Br J Psychiatry 2016; 208: 453-61.
  9. Husain N, Lovell K, ChewGraham CA, et al. Multicentre randomised controlled trial of a group psychological intervention for postnatal depression in British mothers of south Asian origin (ROSHNI2): study protocol. BJPsych Open 2021; 8: e2.
  10. Lunat F, Islam A, Ahmed F. ROSHNI2-using a culturally adapted model of recruitment, engagement and retention to mental health research for British south Asian women experiencing symptoms of postnatal depression. ISSBD Bulletin 2020; 77: 15.
  11. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 2013; 150: 384-88.
  12. Gallis JA, Maselko J, O'Donnell K, et al. Criterionrelated validity and reliability of the Urdu version of the Patient Health Questionnaire in a sample of communitybased pregnant women in Pakistan. PeerJ 2018; 6: e5185.
  13. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD7. Arch Intern Med 2006; 166: 1092-97.
  14. Gater R, Waheed W, Husain N, Tomenson B, Aseem S, Creed F. Social intervention for British Pakistani women with depression: randomised controlled trial. Br J Psych 2010; 197: 227-33.
  15. Brooks R. EuroQol: the current state of play. Health Policy 1996; 37: 53-72.
  16. Rabin R, Gudex C, Selai C, Herdman M. From translation to version management: a history and review of methods for the cultural adaptation of the EuroQol fivedimensional questionnaire. Value Health 2014; 17: 70-76.
  17. Johnstone C, Mash E. A measure of parenting satisfaction and efficacy. J Clin Child Psychol 1989; 18: 167-75.
  18. Waqas A, Nadeem M, Rahman A. Exploring heterogeneity in perinatal depression: a comprehensive review. BMC Psychiatry 2023; 23: 643.
  19. Waqas A, Zafar SW, Akhtar P, Naveed S, Rahman A. Optimizing cognitive and behavioral approaches for perinatal depression: a systematic review and metaregression analysis. Glob Ment Health (Camb) 2023; 10: e22.
  20. Morrell CJ, Slade P, Warner R, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 2009; 338: a3045.
  21. Putnam KT, Wilcox M, RobertsonBlackmore E, et al. Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium. Lancet Psychiatry 2017; 4: 477-85.
  22. Cuijpers P, Quero S, Noma H, et al. Psychotherapies for depression: a network metaanalysis covering efficacy, acceptability and longterm outcomes of all main treatment types. World Psychiatry 2021; 20: 283-93.
  23. Cuijpers P, Franco P, Ciharova M, et al. Psychological treatment of perinatal depression: a metaanalysis. Psychol Med 2023; 53: 2596-608.
  24. Cuijpers P, Karyotaki E. The effects of psychological treatment of perinatal depression: an overview. Arch Womens Ment Health 2021; 24: 801-06.
  25. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
  26. Fuhr DC, Weobong B, Lazarus A, et al. Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India. Lancet Psychiatry 2019; 6: 115-27.
  27. Husain N, Chaudhry N, Furber C, et al. Group psychological intervention for maternal depression: a nested qualitative study from Karachi, Pakistan. World J Psychiatry 2017; 7: 98-105.
  28. Husain N, Kiran T, Shah S, et al. Efficacy of learning through play plus intervention to reduce maternal depression in women with malnourished children: a randomized controlled trial from Pakistan. J Affect Disord 2021; 278: 78-84.
  29. Oram S, Boyce N, Howard LM. Mental health and violence: opportunities for change. Lancet Psychiatry 2019; 6: 558-59.
  30. Oram S, Khalifeh H, Howard LM. Violence against women and mental health. Lancet Psychiatry 2017; 4: 159-70.
  31. Holtrop JS, Estabrooks PA, Gaglio B, et al. Understanding and applying the REAIM framework: clarifications and resources. J Clin Transl Sci 2021; 5: e126. 54

Authors
Husain, N., Lunat, F., Lovell, K., Miah, J., Chew-Graham, C. A., 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.
Affiliations
  • University of Manchester (GB)
  • Lancashire Care NHS Foundation Trust (GB)
  • Greater Manchester Mental Health NHS Foundation Trust (GB)
  • University of Liverpool (GB)
  • Human Development Research Foundation (PK)
  • University of Oxford (GB)
  • University of Leicester (GB)
  • Dow University of Health Sciences (PK)
  • University of Greater Manchester (GB)
  • University of Nottingham (GB)
  • University of Glasgow (GB)
  • Southern Health NHS Foundation Trust (GB)
  • University of York (GB)
  • King's College London (GB)
Corresponding author
Husain, Nusrat
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2024-10
Volume
404
Issue
10461
Pages
1430-1443
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(24)01612-x
OpenAlex
W4403289055
Cited by
27
References
40
Citations by year
2026: 17 · 2025: 8 · 2024: 2
FWCI
11.23
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
  • Health Technology Assessment Programme (14/68/08)
  • Royal Society (224243/Z/21/Z)
  • National Institute for Health and Care Research
  • NIHR Maudsley Biomedical Research Centre
  • Manchester Biomedical Research Centre
  • National Institute of Mental Health
  • Wellcome Trust
  • South London and Maudsley NHS Foundation Trust
  • NIHR Oxford Biomedical Research Centre
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
postpartum depression, British South Asian women, culturally tailored interventions, group cognitive behavioral therapy, non-specialist health workers, maternal mental health, recovery from depression, cultural barriers to treatment, Pakistani women, language barriers, maternal and child outcomes, underserved populations, mental health stigma
MeSH terms
Adult, Female, United Kingdom, Humans, Cognitive Behavioral Therapy, Treatment Outcome, Depression, Postpartum, Asian People, Young Adult, Culturally Competent Care

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