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Gender-informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: cluster randomised controlled trial

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posted on 2023-02-01, 05:02 authored by J Fisher, H Rowe, K Wynter, T Tran, P Lorgelly, Lisa AmirLisa Amir, J Proimos, S Ranasinha, H Hiscock, Jordana BayerJordana Bayer, W Cann
Objectives: Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. Design: Cluster-randomised controlled trial. Setting: 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). Participants: English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. Intervention: WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. Main outcome measures: Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. Results: In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. Conclusions: WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare.


This study was funded by competitively awarded grants from the National Health and Medical Research Council (APP1026550), the Australian Government Department of Social Services (formerly Families, Housing, Community Services and Indigenous Affairs) and the Victorian Department of Education and Training (formerly Department of Education and Early Childhood Development). JF is supported by a Monash Professorial Fellowship and the Jean Hailes Professorial Fellowship, which is supported by a grant to the Jean Hailes Foundation from the H and L Hecht Trust managed by Perpetual Trustees. TT is supported by a Monash Bridging Postdoctoral Fellowship. HH is funded by an Australian National Health and Medical Research Council Career Development Award (No. 607351). Murdoch Childrens Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program.


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