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). (September 2019)

• Record Type: Journal Article
• Authors: Gureje, Oye; Oladeji, Bibilola D.; Montgomery, Alan A.; Araya, Ricardo; Bello, Toyin; Chisholm, Dan; Groleau, Danielle; Kirmayer, Laurence J.; Kola, Lola; Olley, Lydia B.; Tan, Wei; Zelkowitz, Phyllis
• Is Part Of: British journal of psychiatry. Volume 215:Number 3(2019)
• Page Start: 528
• Page End: 535
• Publication Date: 2019-09
• Subjects: Depressive disorders, -- perinatal psychiatry, -- psychosocial interventions, -- primary care; Psychiatry -- Periodicals; Psychology, Pathological -- Periodicals; 616.89005
• DOI: 10.1192/bjp.2019.4
• Languages: English
• ISSNs: 0007-1250

Abstract

Abstract : Background: Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. Aim: To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. Method: 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). 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 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. Conclusions: 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. Declaration of interests: None.