Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data supporting the findings of this study are available within the article.

References

  • Almond P (2009) Postnatal depression: a global public health perspective. Perspectives in Public Health 129:221–7

    Article  Google Scholar 

  • Arifin SRM, Cheyne H, Maxwell M (2018) Review of the prevalence of postnatal depression across cultures. AIMS Public Health 5:260

    Article  Google Scholar 

  • Armstrong KL, Morris J (2000) Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomized controlled trial. J Paediatr Child Health 36:555–62

    Article  CAS  Google Scholar 

  • Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T et al. (2016) Maternal mental health in primary care in five low- and middle-income countries: a situational analysis. BMC Health Serv Res 16:53

  • Beck AT (1961) An Inventory for Measuring Depression. Archives of General Psychiatry 4:561–71

    Article  CAS  Google Scholar 

  • Boath E, Henshaw C (2001) The treatment of postnatal depression: a comprehensive literature review. Journal of Reproductive and Infant Psychology 19:215–48

    Article  Google Scholar 

  • Cooper PJ, De Pascalis L, Woolgar M, Romaniuk H, Murray L (2015) Attempting to prevent postnatal depression by targeting the mother–infant relationship: a randomised controlled trial. Primary health care research & development 16:383–97

    Article  Google Scholar 

  • Cooper PJ, Tomlinson M, Swartz L, Landman M, Molteno C, Stein A et al. (2009) Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomized controlled trial. BMJ 338.

  • de Camps MD, Philipp D, Israel A, Vigod S et al. (2016) Maternal-infant mental health: postpartum group intervention. Arch Womens Ment Health 19:243–51

    Article  Google Scholar 

  • Elliott SA, Leverton TJ, Sanjack M, Turner H, Cowmeadow P, Hopkins J et al. (2000) Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression. Br J Clin Psychol 39:223–41

  • Forman D, O’hara M, Stuart S, Gorman L, Larsen K, Coy KC (2007) Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Dev Psychopathol 19:585–602

    Article  Google Scholar 

  • Grussu P, Quatraro RM (2009) Prevalence and risk factors for a high level of postnatal depression symptomatology in Italian women: a sample drawn from ante-natal classes. European Psychiatry 24:327–33

    Article  Google Scholar 

  • Haithar S, Kuria MW, Sheikh A, Kumar M, Vander Stoep A (2018) Maternal depression and child severe acute malnutrition: a case-control study from Kenya. BMC Pediatr 18:289

    Article  CAS  Google Scholar 

  • Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G et al. (2014) Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS ONE 9:e88437

  • Heh SS, Fu YY (2003) Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan. J Adv Nurs 42:30–6

    Article  Google Scholar 

  • Ho S, Heh S, Jevitt C, Huang L, Fu YY, Wang LL (2009) Effectiveness of a discharge education program in reducing the severity of postpartum depression: a randomized controlled evaluation study. Patient Educ Couns 77:68–71

    Article  Google Scholar 

  • Honey KL, Bennett P, Morgan M (2002) A brief psychoeducational group intervention for postnatal depression. Br J Clin Psychol 41:405–9

    Article  Google Scholar 

  • Hooge SL, Benzies KM, Mannion CA (2014) Effects of a brief, prevention-focused parenting education program for new mothers. West J Nurs Res 36:957–74

    Article  Google Scholar 

  • Horowitz JA, Murphy CA, Gregory KE, Wojcik J (2011) A community based screening initiative to identify mothers at risk for postpartum depression. J Obstet Gynecol Neonatal Nurs 40:52–61

    Article  Google Scholar 

  • Howell EA, Mora P, Leventhal H (2006) Correlates of early postpartum depressive symptoms. Matern Child Health J 10:149–57

    Article  Google Scholar 

  • Howell EA, Mora PA, DiBonaventura MD, Leventhal H (2009) Modifiable factors associated with changes in postpartum depressive symptoms. Arch Womens Ment Health 12:113

    Article  Google Scholar 

  • Kabakian-Khasholian T, Shayboub R, Ataya A (2015) Health after childbirth: patterns of reported postpartum morbidity from Lebanon. Women and Birth 27:15–20

    Article  Google Scholar 

  • Lasater ME, Beebe M, Gresh A, Blomberg K, Warren N (2017) Addressing the unmet need for maternal mental health services in low- and middle-income countries: integrating mental health into maternal health care. J Midwifery Women Health 62:657–60

    Article  Google Scholar 

  • Leckey Y, Hickey G, Stokes A, McGilloway S (2019) Parent and facilitator experiences of an intensive parent and infant programme delivered in routine community settings. Primary Health Care Research & Development 20:E74

    Article  Google Scholar 

  • Lee B, Park HJ (2018) Differences in infant development by trajectories of maternal perinatal depression: based on Malawi mothers and children. Early Child Dev Care 190:1441-51

  • McCarter-Spaulding D, Shea S (2015) Effectiveness of postpartum education in the reducing symptoms of postpartum depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing 44:S58-9

    Article  Google Scholar 

  • MacArthur C, Winter H, Bick D, Knowles H, Lilford R, Henderson C et al. (2002) Effects of redesigned community postnatal care on womens’ health 4 months after birth: a cluster randomized controlled trial. Lancet 359:378–85

  • Madeghe BA, Kiman VN, Stoep AV, Nicodimos S, Kumar M (2016) Postpartum depression and infant feeding practices in a low income urban settlement in Nairobi-Kenya. BMC Res Notes 9:506

  • Mulcahy R, Reay RE, Wilkinson RB, Owen C (2010) A randomized control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression. Arch Womens Ment Health 13:125–39

    Article  Google Scholar 

  • Murray L (1992) The impact of postnatal depression on infant development. J Child Psychol Psychiatry 33:543–61

    Article  CAS  Google Scholar 

  • Ngai FW, Chan SW (2012) Learned resourcefulness, social support and perinatal depression in Chinese Mother. Nursing research 61:78-85

  • Norhayati MN, Hazlina NN, Asrenee AR, Emilin WW (2015) Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 175:34–52

    Article  CAS  Google Scholar 

  • Nylen KJ, Moran TE, Franklin CL, O’hara MW (2006) Maternal depression: a review of relevant treatment approaches for mothers and infants. Infant Ment Health J 27:327–43

    Article  Google Scholar 

  • Ogrodniczuk JS, Piper WE (2003) Preventing postnatal depression: a review of research findings. Harvard Review of Psychiatry 11:291–307

    Article  Google Scholar 

  • Ongeri L, Wanga V, Otieno P, Mbui J, Juma E, Stoep AV et al. (2018) Demographic, psychosocial and clinical factors associated with postpartum depression in Kenyan women. BMC Psychiatry 18:1-9

  • Paris R, Bolton RE, Spielman E (2011) Evaluating a home based dyadic intervention: changes in postpartum depression, maternal perceptions, and mother–infant interactions. Infant Ment Health J 32:319–38

    Article  Google Scholar 

  • Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unützer J (2013) Grand challenges: integrating mental health services into priority health care platforms. PLoS Med 10:e1001448

    Article  Google Scholar 

  • Abdul Raheem R, Chih HJ, Binns CW (2018) Factors associated with maternal depression in the Maldives: a prospective cohort study. Asia Pac J Public Health 30:244–51

  • Rosner B (2011) Fundamentals of biostatistics, 7th edn. Brooks/Cole, Cengage Learning, Boston

    Google Scholar 

  • Shorey S, Chan SW, Chong YS, He HG (2014) A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self-efficacy, social support and postnatal depression among primiparas. J Adv Nurs 71:1260–73

    Article  Google Scholar 

  • Steardo L Jr, Caivano V, Sampogna G, Di Cerbo A, Fico G, Zinno F et al. (2019) Psychoeducational intervention for perinatal depression: study protocol of a randomized controlled trial. Frontiers in Psychiatry 10:15

  • Tammentie T, Tarkka MT, Åstedt-Kurki P, Paavilainen E (2002) Sociodemographic factors of families related to postnatal depressive symptoms of mothers. Int J Nurs Pract 8:240–46

    Article  Google Scholar 

  • Top ED, Karaçam Z (2016) Effectiveness of structured education in reduction of postpartum depression scores: a quasi-experimental study. Arch Psychiatr Nurs 30(3):356–62

    Article  Google Scholar 

  • Ueda M, Yamashita H, Yoshida K (2006) Impact of infant health problems on postnatal depression: pilot study to evaluate a health visiting system. Psychiatry Clin Neurosci 60:182–89

    Article  Google Scholar 

  • Villegas L, McKay K, Dennis CL, Ross LE (2011) Postpartum depression among rural women from developed and developing countries: a systematic review. J Rural Health 27:278–288

    Article  Google Scholar 

  • Werner EA, Gustafsson HC, Lee S, Feng T, Jiang N, Desai P, Monk C (2016) PREPP: postpartum depression prevention through the mother–infant dyad. Womens Ment Health 19:229–42

    Article  Google Scholar 

  • Wiklund I, Mohlkert P, Edman G (2010) Evaluation of a brief cognitive intervention in patients with signs of postnatal depression: a randomized controlled trial. Acta Obstet Gynecol Scand 89:1100–4

    Article  Google Scholar 

  • Woolhouse H, Gartland D, Perlen S, Donath S, Brown SJ (2014) Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study. Midwifery 30:378–384

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, Nairobi, 00100, Kenya

    Esther W. Kariuki, Mary W. Kuria, Fredrick N. Were & David M. Ndetei

  2. Africa Mental Health Research and Training Foundation, Nairobi, Kenya

    David M. Ndetei

Authors
  1. Esther W. Kariuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary W. Kuria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fredrick N. Were
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David M. Ndetei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

This paper is part of a PhD thesis, University of Nairobi. E.W.K. conceived, designed the study and prepared the manuscript. M.W.K supported and gave guidance from conception and design of the study and provided intellectual feedback. F.N.W gave intellectual feedback. D.M.N worked as a senior supervisor and heavily contributed to intellectual feedback study and reviewed the manuscript critically for intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Esther W. Kariuki.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Ethical approval

Approval was obtained from Kenyatta National Hospital Ethical Committee, Office of the President, through the Ministry of Higher Education Science and Technology, the Medical Officer of Health (MOH) Nairobi County.

Consent to participate

All eligible study participants received an explanation about the nature and purpose of the study, their rights, the procedures to be undergone, and potential risks and benefits of participation before they gave a signed consent.

Consent for publication

All authors agree to this article’s publication.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kariuki, E.W., Kuria, M.W., Were, F.N. et al. Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study. Arch Womens Ment Health 24, 503–511 (2021). https://doi.org/10.1007/s00737-020-01085-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-020-01085-1

Keywords

Search

Navigation