Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial

Crick Lund, Marguerite Schneider, Emily Garman, Thandi Davies, Memory Munodawafa, Simone Honikman, Arvin Bhana, Judy Bass, Paul Bolton, Michael Dewey, John Joska, Ahsraf Kagee, Landon Myer, Inge Petersen, Martin Prince, Dan Stein, Hanani Tabana, Graham Thornicroft, Mark Tomlinson, Charlotte HanlonAtalay Alem, Ezra Susser

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Abstract

The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.
Original languageEnglish
Article number103466
Number of pages10
JournalBehaviour Research and Therapy
Volume130
Issue number0
Early online date31 Oct 2019
DOIs
Publication statusPublished - 1 Jul 2020

Keywords

  • Community health workers
  • Counselling
  • Perinatal depression
  • Randomised controlled trial
  • South Africa
  • Task-sharing

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