Preventing postnatal depression and anxiety in new mothers using telephone peer support: a randomised controlled trial.

Telephone peer support - Mothers allocated to the intervention group will receive proactive telephone-based support from a peer volunteer (mother-to-mother), in addition to all standard community services. The trial coordinator will give mothers’ names and contact details to the volunteer coordinator. Peers will initiate early telephone support (within 48 to 72 hours of study recruitment if a woman recruited from a maternal and child health (MCH) centre or within one to two weeks after birth if a woman recruited in hospital after the birth), with a suggested schedule of contacts, but the duration and intensity of the intervention will be flexible based upon maternal desire and need. Telephone contact will proceed as per the set call schedule provided to peer volunteers until the mother is 6 months postpartum. The suggested schedule is telephone calls at weekly intervals for 8 weeks, then every 2 weeks until 6 months postpartum, with flexibility to meet women’s requirements; not all peer support relationships may need to continue for the entire period, and the number of calls may not be the key factor affecting outcomes. There is no restriction (i.e. minimum or maximum) on duration of each phone call. Other communication e.g. texts and emails can be used if both the new mother and peer desire. Peer volunteers will provide appraisal support (helping women appraise their situation, make informed decisions) and emotional support by telephone, thus targeting key risk factors for depression and anxiety, i.e. social isolation and a lack of support. They will also provide information and suggestions about available existing clinical and support services. The goal is to support overcoming help-seeking barriers, not to provide mental health treatment i.e. this proactive approach will lead to more mothers recognising they have a concern or issue, and being referred for (or seeking) support in a timely manner. The focus will be to offer support and a listening ear, and provide women with details of existing local services as needed. If a volunteer considers that the mental health of a mother she is supporting is deteriorating she will consult with the volunteer coordinator (who will consult with the trial perinatal psychiatrist as needed) and refer the mother as appropriate. Peer volunteers are mothers who are empathetic, want to support other mothers, and who have a history of (and have recovered from) postnatal depression and/or anxiety) (self-reported or diagnosed). It is important that peers have a lived experience of this condition, as this promotes empathy, trust, and help-seeking behaviours, and support provided by those who have experienced a similar health problem or stressor has a positive effect on psychological well-being. Recruitment of volunteers will be by advertisements in local newspapers, flyers in MCH Centres, word of mouth and social media. Peer volunteers will undergo an initial 4-hour group training session with 2 follow-up group sessions, the first soon after they have supported their initial woman for 4 weeks. Training will be conducted by the DAISY research team in conjunction with PANDA perinatal Depression & Anxiety Australia educator. The focus of the training will be to develop skills required to provide effective telephone-based support and make appropriate referrals as necessary. Role playing will be a key strategy, and the importance of being non-judgemental, empathic, recognising boundaries and the need for self-care will be addressed. A detailed education package has been developed. A handbook, designed specifically for this study, will be given to peer volunteers, with topics such as how to develop a relationship; skills and techniques for effective telephone support; general perinatal mental health information; and referral pathways. Information on how to respond to a mother who may be experiencing a mental health crisis or who discloses intimate partner violence (IPV), something we expect may come up during support conversations, given its strong association with postnatal depression, will be discussed and prepared for. A module on responding to disclosure of IPV will be included in the training. All peer volunteers agreeing to participate will be assigned an ID number, asked to complete a demographic form, and given activity logs. Activity logs will be used to assess intervention fidelity. Volunteers will be reimbursed $50/woman supported to cover the costs of telephone calls and incidentals. After the education, volunteers who seem unsuitable to provide peer support (as assessed by the volunteer coordinator and the chief investigator present at training, e.g. those with inadequate communication skills or who demonstrate evidence of unresolved depression or anxiety) will not continue to RCT participation, and where required, referrals will be made as needed to appropriate support services. Acceptance as a volunteer will be finalised only after initial training. Peers will sign a confidentiality agreement. A paid volunteer coordinator will organise recruitment of peer volunteers (interview, screen for suitability); (2) help with peer volunteer training sessions; (3) match mothers with appropriate peer volunteer; (4) monitor intervention implementation; and (5) provide support to peer volunteers. The volunteer coordinator will be available to provide support, assistance with any potential participant difficulties, and problem-solving strategies. Regular meetings between volunteers, coordinator and CIs will ensure the volunteers are well supported and taking self-care measures, and will facilitate intervention fidelity. Volunteers will be able to contact the volunteer coordinator and CIs by telephone at other times for information, advice or support.