Journal Article

High- versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial)

Gureje, Oye, Oladeji, Bibilola D., Araya, Ricardo, Bello, Toyin, Tan, Wei, Zelkowitz, Phyllis, Kirmayer, Laurence J., Olley, Lydia B., Montgomery, Alan A., Chisholm, Dan, Kola, Lola, Groleau, Danielle

2019

Overview

Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme - Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 70% with HIT and 66% with LIT: risk difference 4% (95% CI -4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care. None.

• Publisher: Cambridge University Press
• Subject: Breast feeding / Breastfeeding & lactation / Childbirth & labor / Clinical research / Clinical trials / Clinics / Cognition & reasoning / Cost analysis / Critical incidents / Infants / Intervention / Local government / Maternal and infant welfare / Medical personnel / Medical treatment / Mental depression / Mental disorders / Mental health / Mental health care / Mental health services / Mothers / Organizational effectiveness / Perinatal / Postpartum / Postpartum depression / Postpartum period / Postpartum women / Pregnancy / Prenatal care / Primary care / Problem solving / Psychiatry / Psychological intervention / Psychosis / Psychosocial factors / Psychosocial therapy / Public health / Remission / Remission (Medicine) / Womens health / Workers