Trial for Postnatal Depression

• Hamilton Depression Rating Scale (HDRS) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  We will measure change from baseline in symptoms of depression at six months by using 17 item HDRS.
  
  
• Edinburgh Postnatal Depression Scale (EPDS) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  This is 10 item self report questionnaire with four possible responses used to identify mothers with postnatal depression.
  
  

• Infants' weight [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Will be measured through standard anthropometric techniques and equipments
  
  
• Infants' height [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Will be measured through standard anthropometric techniques and equipments
  
  
• OSLO 3-Items Social Support Scale [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  This is a 3 item scale which measures social support of participants from family, friends and neighbourhood
  
  
• EuroQol-5D(EQ-5 D) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  This instrument measures health related quality of life in five dimensions. It provides a simple descriptive profile and a single index value for health status.
  
  
• Maternal Attachment Inventory (MAI) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  It is a 26 item scale that measures maternal attachment with infants
  
  

A number of individual and group interventions targeting maternal depression have been developed and tested, mostly in developed countries. Group-based approaches have usually been used to improve outcomes in children through parent-training programmes. A meta-analysis of such programmes shows that these can also be effective in improving psychosocial and mental health of the mothers. However, a number of health system and cultural differences make it difficult for mental health interventions to be extrapolated from the developed to the developing world.

Design:

The interventions will be assessed using a prospective randomised controlled design, using two groups: psychosocial group therapy (Learning Through Play + principles of Cognitive Behaviour Therapy)and treatment as usual.

Defining the intervention:

The intervention will include a supportive component, an educational component, and practical advice on using health services, a parenting component, and a psychosocial component. The objective will be to help mothers feel supported, empowered and confident about their parenting abilities, which in turn may help to reduce their level of depression. Further qualitative testing of the intervention will take place to refine the manualized intervention.

Psychiatric Measures:

The level of severity of depression will be assessed using the Edinburgh Postnatal Depression Scale (EPDS) (Cox and Holden, 1994) and the Hamilton Depression Rating Scale (HDRS) (Hamilton, 1960).

Women scoring 12 or over on the EPDS and 13 or over on the HDRS will be asked to undergo a diagnostic interview using the Clinical Interview Schedule-Revised (CIS-R).

To measure mother infant attachment the Maternal Attachment Inventory (Muller, 1994) will be used.

OSLO-3 item Social Support Scale (Dalgard, 1996) will be used to measure social support.

The adapted Verona Service Satisfaction Scale (Tansella, 1991) will be used to measure patient satisfaction with support and treatment.

Quality of life will be measured by using the EuroQol-5D (EQ-5D).

The qualitative interviews will be used to elicit information about previous attempts for help with mental health issues and questions regarding participants understanding of their postnatal depression and their future expectations from a perinatal service.