The Durability and Sustainability of Peer-Administered Interventions for Postpartum Depression

Abstract

Objectives: To determine whether peer-administered interventions (PAIs) are effective for the treatment of perinatal depression and anxiety and to examine the effectiveness of an online cognitive behavioural therapy (CBT)-based program delivered by lay peers for postpartum depression (PPD). Methods: In the first study, a systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effectiveness of PAIs for treating perinatal depression or anxiety, and whether variations in intervention types (i.e., peer-delivered psychotherapies, individual peer support, peer discussion groups) impacted their effectiveness. The second study examined the effectiveness and cost-effectiveness of an online nine-week group CBT-informed support intervention for PPD delivered by peers and determined whether peers could assess intervention fidelity and provide effective peer-led psychotherapy supervision to one another with minimal expert involvement. Results: Study 1 found that PAIs were more effective at improving depression symptoms than control conditions. Structured, peer-delivered psychotherapies had the largest effect sizes, followed by individual peer support and peer discussion groups. Taken together, all PAIs were not effective at improving anxiety, though subgroup analyses revealed that peer-delivered psychotherapies did improve anxiety symptoms. Study 2 found that online peer-delivered nine-week group CBT-informed support effectively treats PPD and anxiety with minimal expert involvement and may be cost-effective. The results also suggest that peers effectively rated psychotherapy fidelity. Conclusions: The studies in the present thesis support the potential of task-sharing to peers as nonspecialist providers of perinatal depression treatment. This work suggests that interventions that are structured and based on evidence-based psychotherapies (e.g., CBT) may provide the optimal benefit for those struggling with PPD, and that a nine-week CBT-informed support program is an effective and engaging way to treat PPD and anxiety. This thesis contributes to the evidence that suggests that task-sharing perinatal mental healthcare delivery may be one solution to increase access to care and address barriers to care for perinatal depression.