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.; Montgomery, Alan A.; Araya, Ricardo; Bello, Toyin; Chisholm, Dan; Groleau, Danielle; Kirmayer, Laurence J.; Kola, Lola; Olley, Lydia; Tan, Wei; Zelkowitz, Phyllis

Abstract

Background: Contextually appropriate interventions delivered by primary maternal care providers might be effective in reducing the treatment gap for perinatal depression.
Aim: To compare a high intensity psychological intervention with a low intensity enhanced usual care in the treatment of perinatal depression.
Methods: This cluster randomized clinical trial was conducted in Ibadan, Nigeria between June 18, 2013 and December 11, 2015. Twenty-nine maternal care clinics were randomized to either high intensity (HIT, n=15) or low intensity (LIT, n=14) treatment. Pregnant women, registering for antenatal care, assessed to have DSM-IV major depression, received either enhanced usual care delivered by providers using the WHO Mental Health Gap Action Programme – Intervention Guide (LIT arm) or 8 weekly structured problem solving prenatal sessions delivered within a stepped care model (HIT arm). Primary outcome was recovery from depression 6 months postpartum (score < 6 on the Edinburgh Postnatal Depression Scale, (EPDS).
Results: 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 recovery rates of 70% in the HIT arm and 66% in the LIT arm: adjusted risk difference 4% (95%CI: -4·1%, 12·0%), adjusted odds ratio 1·12 (95%CI: 0·73, 1·72). HIT was more effective among women with higher baseline EPDS scores (adjusted interaction OR 2·29, 95%CI 1·01, 5·20).
Conclusions: Except among more 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.

Citation

Gureje, O., Oladeji, B. D., Montgomery, A. A., Araya, R., Bello, T., Chisholm, D., …Zelkowitz, P. (2019). 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). British Journal of Psychiatry, 215(3), 528-535. https://doi.org/10.1192/bjp.2019.4

• Journal Article Type: Article
• Acceptance Date: Aug 20, 2018
• Online Publication Date: Feb 15, 2019
• Publication Date: Sep 1, 2019
• Deposit Date: Sep 10, 2018
• Publicly Available Date: Aug 16, 2019
• Journal: British Journal of Psychiatry
• Print ISSN: 0007-1250
• Electronic ISSN: 1472-1465
• Publisher: Cambridge University Press
• Peer Reviewed: Peer Reviewed
• Volume: 215
• Issue: 3
• Pages: 528-535
• DOI: https://doi.org/10.1192/bjp.2019.4
• Keywords: Psychiatry and Mental health
• Public URL: https://nottingham-repository.worktribe.com/output/1066611
• Publisher URL: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/high-versus-lowintensity-interventions-for-perinatal-depression-delivered-by-nonspecialist-primary-maternal-care-providers-in-nigeria-cluster-randomised-controlled-trial-the
• Additional Information: This article has been published in a revised form in British Journal of Psychiatry http://doi.org/10.1192/bjp.2019.4. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © The Royal College of Psychiatrists 2019 .
• Contract Date: Feb 26, 2019