Culturally adapted psychological intervention for treating maternal depression in British mothers of African and Caribbean origin: A randomized controlled feasibility trial

Abstract

Background: Women are likely to suffer from maternal depression due to childbirth difficulties and parenting responsibilities, leading to long-term negative consequences on their children and families. British mothers of African/Caribbean origin uptake of mental healthcare is low due to the lack of access to culturally appropriate care. Methods: A mixed-methods randomized controlled feasibility trial was adopted to test the appropriateness and acceptability of Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) for treating maternal depression compared with Psychoeducation (PE). Mothers (N = 26) aged 20-55 were screened for depression using the Patient Health Questionnaire (PHQ-9). Those who scored >5 on PHQ-9 were further interviewed using the Revised Clinical Interview Schedule to confirm the diagnosis and randomized into LTP+CaCBT (n = 13) or PE (n = 13) groups. Assessments were taken at baseline, end of the intervention at 3-and 6-months post-randomization. N = 2 focus groups (LTP+CaCBT, n = 12; PE, n = 7) and N = 8 individual interviews were conducted (LTP+CaCBT, n = 4; PE, n = 4).Results: The LTP+CaCBT group showed higher acceptability, feasibility and satisfaction levels than the PE group. Participants experienced the intervention as beneficial to their parenting skills with reduced depression and anxiety in the LTP+CaCBT compared to the PE group.Conclusions: This is the first feasibility trial of an integrated online parenting intervention for British African and Caribbean mothers. The results indicated that culturally adapted LTP+CaCBT is acceptable and feasible. There is a need to study the clinical and cost-effectiveness of LTP+CaCBT in an appropriately powered randomized control trial and include the child's outcomes.Trial registration. www.ClinicalTrials.gov (no. NCT04820920).

Postnatal depression in British mothers of African and Caribbean origin: a randomised controlled trial of learning through play plus culturally adapted cognitive behaviour therapy compared with psychoeducation

“…The value implication of cultural appropriateness in maternal mental health care is consistent in African/Caribbean mothers ( 24 ). For example, in another study in Kenya, LTP+CaCBT was found to be culturally appropriate and acceptable for treating postnatal depression in rural, low-income and socio-economically disadvantaged women ( 32 ).…”

“…However, it is worth mentioning the cautionary observations made in Jidong et al. ( 24 ) and Notiar et al. ( 32 ) studies which were both feasibility trials with primary outcome measures testing the appropriateness and acceptability of the LTP+CaCBT intervention with small sample sizes of the former n=26 (double arm) and the later n=19 (single arm).…”

“…The study employed an ‘Iterative Model of Co-adaptation’ (IMC) ( 24 ) for the LTP+CaCBT manual to ensure it is culturally appropriate and suitable for British African/Caribbean women. The IMC process includes the following three stages: Stage 1 Translation/co-adaptation of the manual was conducted in Focus Group Participatory Action Research (FG-PAR) with n=21 participants taking cognisance of context-specific factors such as cultural and religious beliefs, language(s), literacy and preferences ( 25 , under review).…”

“…The study employed an ‘Iterative Model of Co-adaptation’ (IMC) ( 24 ) for the LTP+CaCBT manual to ensure it is culturally appropriate and suitable for British African/Caribbean women. The IMC process includes the following three stages: Stage 1 Translation/co-adaptation of the manual was conducted in Focus Group Participatory Action Research (FG-PAR) with n=21 participants taking cognisance of context-specific factors such as cultural and religious beliefs, language(s), literacy and preferences ( 25 , under review). Participants include key stakeholders (i.e., women, clinicians, and researchers), including Patients and Public Involvement Events (PPIE) to understand cultural influences such as views about postnatal depression (idioms of distress and its perceived causes), language and religious implications, and the type and level of support needed for virtual or in-person intervention.…”

“…The outcomes and recommendations from the FG-PAR and PPIE were implemented into the manual and reverted accordingly. Stage 2 Manual testing including (i) Stage 2a: An ‘exploratory’ manual testing in a feasibility trial with a small cohort of n=26 participants was conducted ( 24 ). (ii) Stage 2b: A ‘confirmatory’ testing of the manual was further conducted in the present study to validate the cultural appropriateness and suitability of LTP+CaCBT.…”