Randomised controlled trial, Goa, India
This project tests the effectiveness of a brief home-based intervention developed to support mothers in Goa through late pregnancy and during the early period after birth to reduce the prevalence of postnatal depression (PND). It is the first study in Asia to examine the benefits of providing extra support for childbearing women and their children.
The project has been carried out in collaboration with the Goa-based Sangath Society (Society for Child Development and Family Guidance), a non-governmental organisation working for the welfare of children, young people and their families in the areas of developmental, emotional and behavioural health.
The intervention consisted of five individual support sessions from primary care workers, two of them before the birth and three of them afterwards. The package included information about pregnancy and childcare, individual support and problem solving, and help with early mother/infant interaction. In addition, the support workers from the study team specifically challenged the male child preference that has been shown to be a risk factor for postnatal depression in South Asia.
As well as testing whether the intervention reduces the prevalence of postnatal depression, the research will also gauge whether the infants of women receiving the intervention fare better developmentally.
The Depression After Childbirth Study (DACS) conducted by the Sangath Society showed that 23 per cent of mothers in Goa have postnatal depression six to eight weeks after birth. The odds of an infant both failing to thrive and being developmentally delayed were significantly greater for those born to women with PND than for those whose mothers were psychologically healthy. DACS found three main antenatal risk factors for PND – psychological symptoms during pregnancy, unplanned pregnancy and male child preference.
The intervention being tested is suitable for use in primary care and, if effective, could be widely used.
422 women were recruited in the seventh month of their pregnancy via government nursery schools (Anganwadi centres). Each Anganwadi worker maintains a register of all pregnant women living in her area. Women participating in the randomised controlled trial were identified as being at high risk for postnatal depression, using the three factors identified in DACS.
Half the women were given the intervention and their experiences compared with the other half who were given care as usual from local obstetric services.
Both mothers and their babies were assessed three months after delivery and then again six months after the birth. The researchers have collected data on the proportion of women suffering from depression (using standard interviews and rating scales), as well as the growth and intellectual development of the infants.
Dr Marcus Hughes carried out the research under the supervision of Professor Martin Prince in the Section of Epidemiology and Dr Vikram Patel at the London School of Hygiene and Tropical Medicine. Dr Hughes was funded by a Wellcome Trust Tropical Medicine Training Fellowship. Collaborators in Goa included Kalpana Joshi and Vandana Sardessai from the Sangath Society and Dr Nandita de Souza (from Sethu, Goa).
Advice on the design of the intervention was provided by collaborators Professor Leslie Swartz and Mark Tomlinson, director of the Thula Sana Mother-Infant Project in Cape Town, South Africa.