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| Name | Class |
|---|---|
| Niagara Region Public Health | OTHER |
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Postpartum depression (PPD) affects over 14,000 women in Ontario each year and can have profound effects on mothers, their children, and their families. The cost of one case of PPD exceeds $150,000, a significant proportion of which is related to its impact on offspring. However, difficulties accessing preferred treatments (e.g., psychotherapy) result in fewer than 15% of women receiving care. While Public Health Units have played an important role in PPD detection in Ontario, Public Health Nurses (PHNs) currently lack the skills to deliver evidence-based treatment to women. Cognitive Behavioural Therapy (CBT) delivered in group format is effective for treating depression in the perinatal period, and as PHNs are often the first point of contact for women experiencing PPD, with specialized training it is likely that they can deliver high-quality CBT.
The primary objective of this study is to determine if PHNs can be trained to deliver group Cognitive Behavioral Therapy (CBT) to acutely treat PPD, reduce relapse and recurrence, improve mother-infant attachment and parenting and optimize infant emotional functioning.
In addition to its effects on maternal health, PPD can adversely affect mother-infant attachment, parenting, and the development and health of her children. The negative effects of PPD on offspring can include an increased risk of insecure attachment, poorer cognitive, language, and behavioral development, as well as an increased risk of emotion regulatory problems. To determine if PHNs can effectively deliver group CBT for PPD that is superior to postnatal care as usual, the investigators will proceed with a randomized controlled trial (RCT). Women in the treatment group will attend a 9-week group CBT intervention delivered by trained PHNs. Those in the control group will receive standard postnatal care.
This RCT will compare the effects of group CBT to postnatal care as usual on maternal depression, anxiety, mother-infant attachment, parenting, healthcare utilization and social support, as well as infant development, emotion regulation, and healthcare utilization
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment Group | Experimental | Group CBT for PPD. Women in the treatment group will attend a 9-week group CBT intervention for PPD. This intervention was developed at the Women's Health Concerns Clinic (WHCC) at St. Joseph's Healthcare Hamilton. It was designed to be brief, simple, and applicable to women in community settings. It consists of 9 weekly 2-hour sessions where core CBT skills are learned and practiced, and a new psychoeducational topic is introduced and discussed by women each week. |
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| Control Group | Active Comparator | Standard Care. The usual care group will receive standard care from their family physician and midwife or obstetrician. They will also be made aware of the perinatal programming available to them through Niagara Region Public Health. Women and family physicians will also receive a copy of the Canadian Practice Guidelines for the Treatment of Perinatal Depression. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group Cognitive Behavioral Therapy | Behavioral | 9 weekly 2-hour group CBT sessions delivered by 2 trained Public Health Nurses. |
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| Measure | Description | Time Frame |
|---|---|---|
| Edinburgh Postnatal Depression Scale (EPDS) | The EPDS will be used to assess maternal depression. A score of >12 is consistent with PPD and changes in scores >4 are indicative of clinically significant improvement. | 6 months |
| Mini International Neuropsychiatric Interview - Current Major Depressive Disorder | Used to assess maternal depression. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Penn State Worry Questionnaire (PSWQ) | Maternal Anxiety will be assessed using the Penn State Worry Questionnaire. | 6 months |
| Postpartum Bonding Questionnaire | Used to detect disorders of the mother-infant relationship. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Niagara Region Public Health | Thorold | Ontario | L2V 4Y6 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42383885 | Derived | George KV, Savoy CD, Layton H, Bieling PJ, Van Lieshout RJ. Prevalence of Comorbid Postpartum Depression and Anxiety in Birthing Parents Seeking Treatment for Postpartum Depression: Prevalence de la presence comorbide de la depression et de l'anxiete post-partum chez les parents ayant accouche qui ont consulte en raison de la depression post-partum. Can J Psychiatry. 2026 Jul 1:7067437261462698. doi: 10.1177/07067437261462698. Online ahead of print. | |
| 35060398 |
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| ID | Term |
|---|---|
| D019052 | Depression, Postpartum |
| ID | Term |
|---|---|
| D011644 | Puerperal Disorders |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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| ID | Term |
|---|---|
| D011181 | Postnatal Care |
| ID | Term |
|---|---|
| D018743 | Perinatal Care |
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D008427 | Maternal Health Services |
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| Postnatal Care As Usual | Behavioral | Postnatal care as usual will involve treatment from their family physician and midwife or obstetrician, and voluntary participation in programs offered by Niagara Region Public Health and in the community. |
|
| 6 months |
| Parent-Child Early Relational Assessment | Used to measure the quality of affect and behavior in parent-child interactions. | 6 months |
| Social Provisions Scale | Used to measure the degree to which mothers' social relationships provide support | 6 months |
| Ages and Stages Questionnaires - Third Edition | Assesses infant communication, motor and socioemotional development using age-specific scales. | 6 months |
| Maternal & Infant Healthcare Utilization | Adopted form the Canadian Community Health Survey to track use of healthcare services. | 6 months |
| Infant Behaviour Questionnaire-Revised | This scale assesses infant temperament | 6 months |
| Face-to-Face Still Face Paradigm | Experimental task used to assess emotion regulation in infants | 6 months |
| Parasympathetic Nervous System Functioning: Heart Rate Variability | Used to asses the flexibility of the central and peripheral nervous system to handle stress. | 6 months |
| Salivary Cortisol | Used to assess stress reactivity and emotion regulation. Three samples will be taken during each assessment: 10-15 minutes after the beginning of the assessment, 15-20 minutes after the face-to-face still face task and at the end of the visit. | 6 months |
| Corticolimbic Brain Function: EEG-Based Frontal Lobe Asymmetry (via MUSE Headband) | Corticolimbic brain activity at the scalp will be assessed using electroencephalography (EEG). Greater left frontal asymmetry (greater activity in the left frontal hemisphere) is thought to reflect positive emotionality and indicate a greater tendency to engage in more adaptive emotion regulation strategies. However greater right activity reflects a tendency to engage in withdrawn behaviours and negative emotionality. | 6 months |
| Derived |
| Van Lieshout RJ, Layton H, Savoy CD, Haber E, Feller A, Biscaro A, Bieling PJ, Ferro MA. Public Health Nurse-delivered Group Cognitive Behavioural Therapy for Postpartum Depression: A Randomized Controlled Trial. Can J Psychiatry. 2022 Jun;67(6):432-440. doi: 10.1177/07067437221074426. Epub 2022 Jan 21. |
| D003866 | Depressive Disorder |
| D019964 | Mood Disorders |
| D001523 | Mental Disorders |
| D003153 |
| Community Health Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |