Postnatal depression (PND) is a global problem and an important public health issue. It is estimated that approximately 15% of women experience depression during the first postnatal year but there are problems in recognition because its clinical assessment can be complex. The incidence of postnatal depression continues to rise resulting in serious consequences for the mother, her child and the extended family and a risk of suicide (the leading cause of maternal death in England and Wales) and infanticide in some severely depressed mothers.
Treatment programmes vary considerably but many studies are suggesting that psychological interventions can be as equally, if not more, clinically effective in the management of depression as routine care from a general practitioner or anti-depressants in the short term – and may be more cost effective.
The aim of this exploratory pilot study is to identify whether the support, on a one to one basis, from a Peer Support Worker (PSW) would assist in the reduction of PND in new mothers. Eight PSW’s were recruited. Each PSW had previously suffered from mild to moderate postnatal depression but had recovered and were not currently receiving any form of psychological support or taking any medication. They were employed, on a six month contract, by the local NHS trust. References and enhanced criminal records clearance were obtained. A confidentiality statement was also signed by the PSW.
Thirty mothers were recruited by their own Health Visitor. This was carried out using the Edinburgh Postnatal Depression Scoring documentation (EPDS) alongside a clinical assessment. The cut off score, as agreed by both the lead researcher and the Health Visitors involved in the study, was 11. Fully informed consent was obtained and participant information sheets given. The mothers were allocated into either a Control group or an Intervention group using number alternating.
The PSW’s received formal training about child protection procedures/safeguarding children in addition to the relevance and importance of confidentiality. However, apart from this, a structured training programme was not adhered to. The PSW’s strongly felt, as a combined group, that they wanted to provide the intervention simply as a ‘fellow mum who had survived the rollercoaster journey of PND’. Each PSW wanted to identify the nature of the problem, find a possible solution, and design their own proposed ‘support package’ – from the outset of the study.
The PSW visited the mother in their home environment, or a location of their choice, for a period of six weeks on a once weekly basis (intervention group). This was then compared to a number of mothers who received support from their family Health Visitor (HV) alone (control group). Data collected was both qualitative and quantitative. The PSW's and the mothers from both the control group and the intervention group were asked to maintain a log book reflecting upon their feelings and thoughts after each visit (either from their PSW or their HV). Individual and group supervisory sessions were also offered by the lead researcher to both the mothers within the intervention group, and the control group, in addition to the PSW’s. A number of the participants were interviewed on a one to one basis when their infant was six months old. Data from the interviews was subsequently transcribed, coded and catergorised, and key themes identified.
Quantitative data was collated in the form of an Edinburgh Postnatal Depression Score (EPDS) – an assessment tool which is routinely used to identify mothers at risk or suffering from postnatal depression. The EPDS score was recorded prior to the support commencing by either a PSW or the Health Visitor, after completion of all six visits, and when the infant was six months old.
The EPDS scores recorded at 6 weeks, 12 weeks, and again when the infant was six months old, were analysed and summarised using graphs and charts. Non parametric analysis using Friedman’s Anova and the Wilcoxon paired test was carried out. A Mann Whitney test, Kolmogorov-Smirrov test and a Shapiro-Wilk test were also performed.
A constant comparative method was used as a means of analysing the qualitative data collected from both log books and interview transcript (Denscombe 2008). The lead researcher consistently read and re-read text data, compared new codes and categories as they emerged and repeatedly compared them against existing versions. This process enabled the researcher to refine and improve the explanatory power of the concepts and theories generated from the data. Similarities and differences were highlighted and categories and codes were identified. On completion of this analysis, all participants were contacted to ensure validity of the findings and that each participant agreed with the researchers interpretation of the data collected.
Qualitative and quantitative findings from this study suggest that the input from a PSW does assist in the reduction of PND in new mothers. This is demonstrated in both the analysis of the quantitative data and the qualitative.
The EPDS scores demonstrated little difference between the participants at 6 weeks but the statistics started to diverge at 12 weeks – the mean at 12 weeks for the control group is recorded at 12.46 and the intervention group is 10.33 – a difference of 2.13. The EPDS at six months demonstrates a difference between the two scores as 2.67 (the control group mean recording is 11.60 compared with the intervention mean which is 8.93).
The key themes identified were the immeasurable value of ‘social support’ and ‘shared experiences’. The resounding factor that appears repeatedly throughout the analysis of data is the fact that the mothers could ‘truly relate to their Worker.’ Their PSW gave them ‘hope’, made them feel as if they were ‘not a failure’ and gave them an overwhelming ‘sense of normality’. This, in turn, increased their self-esteem, their positivity towards their parenting role, and their ability to therefore be ‘a good mother.’ A major strength of the work was the involvement of the PSW’s in both the planning and the implementing of the intervention. It was their design, their creation, and their feelings about what may really help their mother.
A number of other themes were also identified that were, interestingly, commonalities across the entire data set (participants and PSW’s). These included recognition of their own changing perspective – a realisation that there simply is no ‘quick fix’ solution, that both time and support are required. The PSW’s described feelings of ‘personal benefit’, ‘self-awareness’ and the ‘provision of closure’ for themselves. The intervention group also talked, at length, about their ‘personal benefit’ from the PSW, and their own self-awareness about how they truly felt, their emotions and, in some instances, why they felt this way. The control group recognised the huge advantage from talking to other mothers and, although they did not have the formal support sessions from a PSW, they embraced the opportunity of sharing their thoughts and feelings with ‘fellow mums’. Each participant, and PSW, discussed the sharing of experiences, empathy, the feeling of ‘release’ and, particularly on the mothers’ part, the importance of knowing that, actually, they are not ‘alone’.
The aim of this study was to provide early intervention to mothers who were classed as ‘at risk’ of suffering from PND, and, indeed, the support from the PSW’s did appear to have a positive impact upon the mothers’ mental health and wellbeing. However, this was a small scale, pilot study over a relatively short period of time. Larger, more longitudinal studies are certainly required. The importance of the pilot study presented here lies in its usefulness in shaping research to investigate and explore further whether there are indeed beneficial factors to post-natally depressed mothers who receive one to one support from a PSW. The positive results from this study can, potentially, have a huge impact within practice and, most importantly, upon the lives of those affected by postnatal depression.||en