Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-13T01:13:11.683Z Has data issue: false hasContentIssue false
  • English
  • Français

A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial

Published online by Cambridge University Press:  25 March 2015

A. J. Daley ,
R. V. Blamey ,
K. Jolly ,
A. K. Roalfe ,
K. M. Turner ,
S. Coleman ,
M. McGuinness ,
I. Jones ,
D. J. Sharp  and
C. MacArthur
A. J. Daley
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
R. V. Blamey
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
K. Jolly*
Affiliation:
Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
A. K. Roalfe
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
K. M. Turner
Affiliation:
Academic Unit of Primary Health Care, University of Bristol, Bristol, UK
S. Coleman
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
M. McGuinness
Affiliation:
Perinatal Mental Health Service, The Barberry, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
I. Jones
Affiliation:
Institute of Psychological Medicine and Clinical Neurology, Cardiff University, Cardiff, UK
D. J. Sharp
Affiliation:
Academic Unit of Primary Health Care, University of Bristol, Bristol, UK
C. MacArthur
Affiliation:
Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
*
*Address for correspondence: K. Jolly, Ph.D., Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK. (Email: c.b.jolly@bham.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Postnatal depression affects about 10–15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression.

Method

Women who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization.

Results

A total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a −2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) −4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = −2.26, 95% CI −4.36 to −0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up.

Conclusions

This trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.

Keywords

Depressionexercisepostnatal depressionprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 11 , August 2015 , pp. 2413 - 2425
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Affonso, DD, De, AK, Horowitz, JA, Malberry, LJ (2000). An international study exploring levels of postpartum depressive symptomatology. Journal of Psychosomatic Research 49, 207–216.Google Scholar
American College of Obstetrics and Gynecology (ACOG) (2002). Committee Obstetric Practice. ACOG Committee opinion. Number 267, Exercise during pregnancy and the postpartum period. Obstetrics and Gynecology 99, 171–173.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Armstrong, K, Edwards, H (2003). The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial. International Journal of Mental Health Nursing 12, 130–138.Google Scholar
Beck, C (1995). The effects of postpartum depression on maternal–infant interactions: a meta analysis. Nursing Research 44, 298–304.CrossRefGoogle ScholarPubMed
Blamey, RV, Daley, AJ, Jolly, K (2012). Exercise for postnatal psychological outcomes: a systematic review and meta-analysis. Lancet 38, S25.CrossRefGoogle Scholar
Bostic, TJ, Rubio, DM, Hood, M (2000). A validation of the Subjective Vitality Scale using structural equation modeling. Social Indicators Research 52, 313–324.CrossRefGoogle Scholar
Brooks, R (1996). EuroQol: the current state of play. Health Policy 37, 53–72.CrossRefGoogle ScholarPubMed
Cooper, PJ, Murray, L (1995). Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. British Journal of Psychiatry 166, 191–195.Google Scholar
Cox, J, Holden, J, Sagovsky, R (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150, 782–786.Google Scholar
Craig, CL, Marshall, AL, Sjöström, M, Bauman, AE, Booth, ML, Ainsworth, BE, Pratt, M, Ekelund, U, Yngve, A, Sallis, JF, Oja, P (2003). International Physical Activity Questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise 35, 1381–1395.CrossRefGoogle ScholarPubMed
Daley, AJ, Jolly, K, MacArthur, C (2009). The effectiveness of exercise in the management of postnatal depression: systematic review and meta-analysis. Family Practice 26, 154–162.Google Scholar
Daley, AJ, Jolly, K, Sharp, DJ, Turner, KM, Blamey, RV, Coleman, SJ, McGuinness, M, Roalfe, AK, Jones, I, MacArthur, C (2012). The effectiveness of exercise as a treatment for postnatal depression: study protocol. Biomed Central Pregnancy and Childbirth 12, 45.Google Scholar
Daley, AJ, MacArthur, C, Winter, H (2007). The role of exercise as a treatment for postnatal depression: a review. Journal of Midwifery and Women's Health 52, 56–62.Google Scholar
Daley, AJ, Winter, HR, Grimmett, C, McGuinness, M, McManus, R, MacArthur, C (2008). The feasibility of an exercise intervention in depressed postnatal women: a pilot randomised controlled trial. British Journal of General Practice 58, 178–183.CrossRefGoogle ScholarPubMed
Dennis, C-L, Hodnett, E (2007). Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews Issue 4, Art. No: CD006116. doi:10.1002/14651858.CD006116.pub2.Google Scholar
Department of Health (2004). At least five a week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. April 2004 (www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4080994). Accessed 11 January 2007.Google Scholar
Gaynes, BN, Gavin, N, Melzer-Brody, S, Lohr, KN, Swinson, T, Gartlehner, G, Brody, S (2005). Perinatal Depression: Prevalence, Screening Accuracy and Screening Outcomes. Summary, Evidence Report/Technology Assessment no. 119. Prepared by RTI-University of North Carolina Evidence based Practice Center under contract No. 290-02-0016. AHRQ Publication No. 05-E006-1. Agency for Healthcare Research and Quality: Rockville, MD.Google ScholarPubMed
Heh, S, Huang, L, Ho, S, Fu, Y, Wang, L (2008). Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women. Birth 35, 60–65.Google Scholar
Jacobson, NS, Traux, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting Clinical Psychology 59, 12–19.CrossRefGoogle Scholar
Jenkins, R, Lewis, G, Bebbington, P, Brugha, T, Farrell, M, Gill, B, Meltzer, H (1997). The National Psychiatric Morbidity Surveys of Great Britain – initial findings from the Household Survey. Psychological Medicine 27, 775–789.CrossRefGoogle ScholarPubMed
Krusche, A, Rudolf von Rohr, I, Muse, K, Duggan, D, Crane, C, Williams, JM (2014). An evaluation of the effectiveness of recruitment methods: the Staying Well After Depression randomized controlled trial. Clinical Trials 11, 141–149.CrossRefGoogle ScholarPubMed
Kumar, R, Robson, KM, Smith, AM (1984). Development of a self-administered questionnaire to measure maternal adjustment and maternal attitudes during pregnancy and after delivery. Journal of Psychosomatic Research 28, 43–51.Google Scholar
Lewis, BA, Gjerdingen, DK, Avery, MD, Sirard, JR, Guo, H, Schuver, K, Marcus, BH (2014). Randomized trial examining a physical activity intervention for the prevention of postpartum depression: The Healthy Mom Trial. Mental Health and Physical Activity 7, 42–49.CrossRefGoogle Scholar
Lewis, G (1994). Assessing psychiatric disorder with a human interviewer or a computer. Journal of Epidemiology and Community Health 48, 207–210.Google Scholar
Lewis, G, Pelosi, A, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine 22, 465–488.Google Scholar
Matthey, S (2004). Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders 78, 269–272.Google Scholar
McLennan, D, Barnes, H, Noble, M, Davies, J, Garratt, E (2011). The English Indices of Deprivation 2010. Department for Communities and Local Government: London (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/6320/1870718.pdf). Accessed 9 June 2012.Google Scholar
Morrell, CJ, Slade, P, Warner, R, Paley, G, Dixon, S, Walters, SJ, Brugha, T, Barkham, M, Parry, GJ, Nicholl, J (2009). Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. British Medical Journal 338, a3045.Google Scholar
Murray, L (1992). The impact of postnatal depression on infant development. Journal of Child Psychology and Psychiatry 33, 543–561.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (2007). CG45 Antenatal and Postnatal Mental Health. Clinical Management and Service Guidance. NHS: London.Google Scholar
O'Hara, M, Swain, A (1996). Rates and risk of postpartum depression – a meta analysis. International Review of Psychiatry 8, 37–54.Google Scholar
Sallis, JF, Grossman, RM, Pinski, RB, Patterson, TL, Nader, PR (1987). The development of scales to measure social support for diet and exercise behaviours. Preventive Medicine 16, 825–836.Google Scholar
Sallis, JF, Pinski, RB, Grossman, RM (1988). The development of self-efficacy scales for health-related diet and exercise behaviours. Health Education Research 3, 283–292.CrossRefGoogle Scholar
Sharp, DJ, Chew-Graham, C, Tylee, A, Lewis, G, Howard, L, Anderson, I, Abel, K, Turner, KM, Hollinghurst, SP, Tallon, D, McCarthy, A, Peters, TJ (2010). A pragmatic randomised controlled trial to compare antidepressants with a community-based psychosocial intervention for the treatment of women with postnatal depression: the RESPOND trial. Health Technology Assessment 14, iii–iv, ix–xi, 1–153.CrossRefGoogle ScholarPubMed
Singleton, N, Lewis, G (2003). Better or Worse: a Longitudinal Study of the Mental Health of Adults Living in Private Households in Great Britain. Office for National Statistics, Her Majesty's Stationery Office: London.Google ScholarPubMed
Turner, K, Chew-Graham, C, Folkes, L, Sharp, D (2010). Women's experiences of health visitor delivered listening visits as a treatment for postnatal depression: a qualitative study. Patient Education and Counseling 78, 234–239.CrossRefGoogle ScholarPubMed
Turner, K, Sharp, D, Folkes, L, Chew-Graham, C (2008). Women's views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study. Family Practice 25, 450–455.Google Scholar
Ware, JE, Kosinski, M, Keller, SD (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220–233.CrossRefGoogle ScholarPubMed
World Health Organization (2011). International Classification of Disease and Health Related Problems version 10 (http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf). Accessed 9 June 2012.Google Scholar
Supplementary material: File

Daley supplementary material

Tables S1 and S2

Download Daley supplementary material(File)
File 46.6 KB