Postpartum depression peer support: Maternal perceptions from a randomized controlled trial☆

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Abstract

Background

Peer support in the early postpartum period is effective in the prevention of postpartum depression among women identified as high-risk.

Objectives

To describe maternal perceptions of peer support received while participating in a trial.

Design

Cross-sectional survey of women participating in a randomized controlled trial to evaluate the effect of peer support in the prevention of postpartum depression.

Setting

Seven health regions across Ontario Canada.

Participants

701 women were recruited between November 2004 and September 2006. Women eligible for the study were all mothers with an Edinburgh Postnatal Depression Scale score >9 who were within 2 weeks postpartum, at least 18 years of age, able to speak English, had a live birth, and had been discharged home from the hospital. Exclusion criteria included an infant not discharged home with the mother and current use of antidepressant or antipsychotic medication. Two hundred and twenty-one mothers completed the mailed questionnaire.

Methods

Women were randomly allocated to receive usual postpartum care (control group) or usual postpartum care plus telephone-based peer support (intervention group). Maternal perceptions of peer support were evaluated at 12 weeks postpartum using the validated Peer Support Evaluation Inventory.

Results

Interactions provided by the peer volunteer included the provision of emotional (92.7%), informational (72.4%), and appraisal (72.0%) support. Mothers reported high levels of positive relationship qualities such as trust (83.6%) and perceived acceptance (79.1%). Most (80.5%) mothers indicated they were very satisfied with their peer support experience. Maternal satisfaction was associated with the number and duration of peer volunteer contacts.

Conclusions

The majority of mothers perceived their peer volunteer experience positively lending further support to telephone-based peer support as a preventative strategy for postpartum depression. The following program modifications were suggested: (a) adapt training to enhance the provision of appraisal support; (b) improve matching of volunteers to participants based on age, number of children, and breastfeeding status; and (c) ensure participating mothers want to receive peer support in order to facilitate the development of relationships with their assigned peers.

Section snippets

Background

Postpartum mood disorders represent the most frequent form of maternal morbidity after childbirth (Stocky and Lynch, 2000). These disorders range in severity from the early maternity “blues” to postpartum psychosis (Evins and Theofrastous, 1997) and include postpartum depression, a condition comprised of the often disabling symptoms of dysphoria, emotional liability, insomnia, confusion, anxiety, guilt, and suicidal ideation. A recent meta-analysis of 30 studies reported prevalence rates for

Peer support evaluation inventory

The validated Peer Support Evaluation Inventory (PSEI) (Dennis, 2003b) was used to provide an in-depth assessment of maternal perspectives of the intervention at 12 weeks postpartum. The PSEI is a 4-subscale self-report instrument developed to measure an individual's perception of support received from a peer. The first subscale assessed supportive interactions (e.g., emotional, appraisal, and informational support) and included 15 items. The second subscale assessed relationship qualities

Maternal perceptions of peer support

At 12 weeks postpartum, 221 (63.3%) mothers in the intervention group returned their mailed evaluations of their peer volunteer experiences. Among these mothers, 19 (8.6%) indicated that they never spoke to their peer volunteer for several reasons such as: (a) peer volunteer did not telephone, (b) missed each other's calls, (c) no longer interested in receiving peer support, and (d) had enough support. These 19 mothers did not complete the returned PSEI. There was no significant difference

Discussion

Social support experts have recommended that peer support interactions be comprehensively analyzed in order to promote a theoretical understanding of peer support mechanisms and the development of more effective intervention (Cohen et al., 2002). In this trial, the majority of peer volunteers provided emotional support, and three quarters of the relationships included both informational and appraisal support. This finding is consistent with a peer support concept analysis (Dennis, 2003a) and

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    Trial ISRCTN registration: 68337727.

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