Postpartum depression (PPD) affects over 14,000 women in Ontario each year and can have profound effects on mothers, their children, and their families. The cost of one case of PPD exceeds $150,000, a significant proportion of which is related to its impact on offspring. However, difficulties accessing preferred treatments (e.g., psychotherapy) result in fewer than 15% of women receiving care. While Public Health Units have played an important role in PPD detection in Ontario, Public Health Nurses (PHNs) currently lack the skills to deliver evidence-based treatment to women. Cognitive Behavioural Therapy (CBT) delivered in group format is effective for treating depression in the perinatal period, and as PHNs are often the first point of contact for women experiencing PPD, with specialized training it is likely that they can deliver high-quality CBT. The primary objective of this study is to determine if PHNs can be trained to deliver group Cognitive Behavioral Therapy (CBT) to acutely treat PPD, reduce relapse and recurrence, improve mother-infant attachment and parenting and optimize infant emotional functioning.
In addition to its effects on maternal health, PPD can adversely affect mother-infant attachment, parenting, and the development and health of her children. The negative effects of PPD on offspring can include an increased risk of insecure attachment, poorer cognitive, language, and behavioral development, as well as an increased risk of emotion regulatory problems. To determine if PHNs can effectively deliver group CBT for PPD that is superior to postnatal care as usual, the investigators will proceed with a randomized controlled trial (RCT). Women in the treatment group will attend a 9-week group CBT intervention delivered by trained PHNs. Those in the control group will receive standard postnatal care. This RCT will compare the effects of group CBT to postnatal care as usual on maternal depression, anxiety, mother-infant attachment, parenting, healthcare utilization and social support, as well as infant development, emotion regulation, and healthcare utilization
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
141
9 weekly 2-hour group CBT sessions delivered by 2 trained Public Health Nurses.
Postnatal care as usual will involve treatment from their family physician and midwife or obstetrician, and voluntary participation in programs offered by Niagara Region Public Health and in the community.
Niagara Region Public Health
Thorold, Ontario, Canada
Edinburgh Postnatal Depression Scale (EPDS)
The EPDS will be used to assess maternal depression. A score of \>12 is consistent with PPD and changes in scores \>4 are indicative of clinically significant improvement.
Time frame: 6 months
Mini International Neuropsychiatric Interview - Current Major Depressive Disorder
Used to assess maternal depression.
Time frame: 6 months
Penn State Worry Questionnaire (PSWQ)
Maternal Anxiety will be assessed using the Penn State Worry Questionnaire.
Time frame: 6 months
Postpartum Bonding Questionnaire
Used to detect disorders of the mother-infant relationship.
Time frame: 6 months
Parent-Child Early Relational Assessment
Used to measure the quality of affect and behavior in parent-child interactions.
Time frame: 6 months
Social Provisions Scale
Used to measure the degree to which mothers' social relationships provide support
Time frame: 6 months
Ages and Stages Questionnaires - Third Edition
Assesses infant communication, motor and socioemotional development using age-specific scales.
Time frame: 6 months
Maternal & Infant Healthcare Utilization
Adopted form the Canadian Community Health Survey to track use of healthcare services.
Time frame: 6 months
Infant Behaviour Questionnaire-Revised
This scale assesses infant temperament
Time frame: 6 months
Face-to-Face Still Face Paradigm
Experimental task used to assess emotion regulation in infants
Time frame: 6 months
Parasympathetic Nervous System Functioning: Heart Rate Variability
Used to asses the flexibility of the central and peripheral nervous system to handle stress.
Time frame: 6 months
Salivary Cortisol
Used to assess stress reactivity and emotion regulation. Three samples will be taken during each assessment: 10-15 minutes after the beginning of the assessment, 15-20 minutes after the face-to-face still face task and at the end of the visit.
Time frame: 6 months
Corticolimbic Brain Function: EEG-Based Frontal Lobe Asymmetry (via MUSE Headband)
Corticolimbic brain activity at the scalp will be assessed using electroencephalography (EEG). Greater left frontal asymmetry (greater activity in the left frontal hemisphere) is thought to reflect positive emotionality and indicate a greater tendency to engage in more adaptive emotion regulation strategies. However greater right activity reflects a tendency to engage in withdrawn behaviours and negative emotionality.
Time frame: 6 months
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