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A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women’s Health Clinics

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Abstract

Objective

To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel.

Methods

We conducted a non-randomized controlled trial at two women’s health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26–38 weeks of pregnancy (Time 1) and one 2–4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic.

Results

The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003).

Conclusions

In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women’s clinics during pregnancy.

Clinical Trial Registry

ClinicalTrials.gov NCT02862444.

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Acknowledgements

We are grateful to the research participants for their willing cooperation and patience. We thank Clalit Healthcare Services for their assistance in facilitating this study. And we are grateful to the Ministry of Science and Technology for their support.

Funding

The study was funded by the Ministry of Science and Technology, Grant No. 8762591, Israel.

Author information

Authors and Affiliations

  1. Center for Women’s Health Studies and Promotion, Ben-Gurion University of the Negev, POB 653, 8410501, Beer-Sheva, Israel

    Samira Alfayumi-Zeadna

  2. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada

    Samira Alfayumi-Zeadna

  3. Department of Obstetrics/Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Atif Zeadna

  4. Clalit Health Services, Southern Region, Beer-Sheva, Israel

    Zuya Azbarga, Lobna Salman, Miron Froimovici & Awad Alkatnany

  5. Israeli Ministry of Health, Jerusalem, Israel

    Itamar Grotto

  6. Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Nihaya Daoud

Authors
  1. Samira Alfayumi-Zeadna
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  2. Atif Zeadna
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  3. Zuya Azbarga
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  4. Lobna Salman
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  5. Miron Froimovici
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  6. Awad Alkatnany
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  7. Itamar Grotto
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  8. Nihaya Daoud
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Contributions

SAZ, ND and MF: contributed to the design and implementation of the research, SAZ: was the primary investigator and supervised the data collection, data cleaning, and analysis. SAZ, ZA, LS, AK: conducted the data collection, provided counseling, follow-up, and treatment to participants. SAZ and ND: conducted the data analyses. AZ and IG: provided counseling, feedback and editing the manuscript. All authors helped shape the research and manuscript.

Corresponding author

Correspondence to Samira Alfayumi-Zeadna.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

Ethics approval for this study was obtained from Helsinki Committee of Clalit Health Care Services (0004–16-COM2).

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Appendix

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Table 5 Distribution of study variables among women in the intervention and control groups who completed both interviews in Time 1 and Time 2, and among women who lost at follow up (Total N = 332)
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Alfayumi-Zeadna, S., Zeadna, A., Azbarga, Z. et al. A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women’s Health Clinics. Matern Child Health J 26, 1689–1700 (2022). https://doi.org/10.1007/s10995-022-03434-1

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