‘Improving health and wellbeing through Research’ Preston Football Club 17th October 2014 Improving health and wellbeing through research – October 2014 Dr Nusrat Husain Reader (University of Manchester) / Honorary Consultant Psychiatrist “ROSHNI-D: An exploratory randomised control trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin” Improving health and wellbeing through research – October 2014 Theme: Developing Clinical Research Increasing access to culturally sensitive Psychological Interventions Nusrat Husain Reader in Psychiatry Lead Global Mental Health Institute of Brain, Behaviour and Mental Health University of Manchester Research Director Global Health Manchester Academic Health Sciences Centre (MAHSC) Honorary Consultant Psychiatrist Lead Culture & International Mental Health Research Group Lancashire Care NHS Foundation Trust Honorary Director R&D Pakistan Institute of Learning & Living Honorary Research Consultant Centre in Africa for Learning & Living Visiting Research Faculty Hincks DellCrest , University of Toronto ROSHNI-D - Exploratory RCT of a grOup psychological intervention for PoStnatal Depression in BritisH Mothers of South AsiaN OrigIn • Culturally appropriate group psychosocial intervention • Based on the principles of Cognitive Behaviour Therapy • Developed by PHD student now Dr. Sobia Khan and has been pre-tested on a group of 12 women 1 in 6 of England's population belonging to an ethnic minority a increase from 6.6 million in 2001 to 9.1 million in 2009 (ONS, 2011) Source: 2001 Census [Key Statistics for England and Wales Source: 2011 Census, Table KS201EW, ONS Challenges: Mental Health Disparities • Ethnic and racial minorities: – Less access to, and availability of, mental health services – Less likely to receive needed mental health services – Those in treatment often receive a poorer quality of mental health care – Underrepresented in mental health research – Experience a greater burden of disability Perinatal depression among British Pakistani women – Social isolation – Language difficulties, don’t speak English fluently – Unemployment – Lack of satisfactory confiding relationship – Low self esteem – Rarely leave home, and then only accompanied by husband or other family member The depression cycle of Pakistani Women Marital problems Loss of hope and future aspirations Low self esteem Poor physical health Social isolation Lack of social support “Cultural adaptation refers to program modifications that are culturally sensitive & tailored to a cultural group’s traditional world views.” (Kumpfer, 2002). ROSHNI-D: POSITIVE HEALTH PROGRAMME (PHP) (POSTNATAL DEPRESSION) • Culturally appropriate group psychosocial intervention • Based on the principles of Cognitive Behaviour Therapy • Developed by PHD student now Dr. Sobia Khan and has been pre-tested on a group of 12 women RCT of a Complex Intervention for Postnatal Depression in British Mothers of South Asian Origin A letter from the GP at 6 weeks postnatal informed the women about the trial, invite their participation and request their written informed consent Women who score =≥12 on EPDS and a selection of low scorers were invited for the second stage interviews All consenting women were administered the Clinical Interview Schedule Revised CIS-R to confirm the ICD 10 diagnosis of depression Women who fulfilled the inclusion criteria were then asked to provide a second written consent for randomization Positive Health Programme (PHP) • Session 1: Introduction to the PHP • Session 2: Pressures and expectations of women EXAMPLES AND STORIES ARE USED IN THE MANUAL TO HELP WOMEN UNDERSTAND THE VICIOUS CIRCLE OF DEPRESSION (ABC MODEL) I don’t play with the children anymore I can’t do anything right I can’t get to sleep Session 3 -Understanding and managing self-esteem • Understanding the role of our thoughts and feelings on our behaviour in maintaining low self esteem • To encourage members to implement change in their lives in terms of achieving good selfesteem Session 4 - Keeping up with the Chaudhrys (Joneses) • To unveil feelings of envy and jealousy and learn from others • Life is NOT a race Session 5 – Exercise and looking good • Identify the pressures on women wanting to look good • To identify negative feelings associated with our body image • To discuss the consequences of dieting or overeating • The looking good and feeling good connection • Exercise as a way of managing good weight Session 6- Religion and Spirituality • Identifying negative beliefs about “Punishment from God” • To challenge our negative thoughts regarding religion using the ABC model • Using spirituality as means of increasing inner calm Positive Health Programme (PHP) • Session 7: Relaxation • Session 8: Assertiveness and confidence • Session 9: Breaking social isolation • Session 10: Discussion group • Session 11: Discussion group Final Session (12th) • Goodbye session • Planned as completion of training and certificate distribution ceremony • All dressed up • Exchange contacts RESULTS: Demographics Intervention Age mean (S.D) Control Total 30.43(5.96) 30.05(5.37) - 5 (11.90% 7 (17.07%) 12 (14.46%) 36 (85.71%) 32 (78.05%) 68 (81.93%) 1 (02.38%) - 1 (01.20%) - 2 (4.88%) 2 (02.41%) Ethnicity N (%) Indian Pakistani Other Asian Unknown EPDS Score Intervention Control Baseline Follow-up 1 16.69 8.03 15.17 8.53 Follow-up 2 9.38 9.07 P-value NS 18.00 16.00 14.00 12.00 10.00 Intervention Control 8.00 6.00 4.00 2.00 - Baseline Follow-up 1 Follow-up 2 Attendance at Roshni-D Groups (mean 6.6 – 10.4) 30 No. of Participants 25 20 15 10 5 Attenders 0 Wk 1 Wk 2 Wk3 Wk4 Wk5 Wk6 Wk7 Wk8 Wk9 Wk10 Attenders Wk11 Wk12 Analysis of Completers • Completers were defined as those participants who had attended 4 or more sessions. • Fifteen of the 42 patients in the intervention group did not attend any of the therapy sessions, while the remaining 27 patients attended at least 4 sessions. • Spearman’s correlation coefficient between the number of sessions attended and reduction in Hamilton score from baseline to follow up 1 was 0.35, p=0.048, with greater reductions in Hamilton score being associated with more sessions attended. • Correlations between changes from baseline to follow-ups in the other variables ranged from 0.20 for EPDS at 2nd follow up to 0.40 for DAS at 2nd follow up. Results • All the participants reported improved well-being since attending the PHP. • Women reported improvements in their lifestyle by being more proactive, enhanced self-esteem, being able to manage stress more effectively. • Embracing and adopting a positive view of life. “I am very open now, my behaviour has changed a lot, before I was very reluctant to speak and was yes there is difference, I am more open with people I try to be more communicative and friendly when I go out. It’s an overall change in attitude” Conclusion • The findings suggest that a culturally adapted intervention (PHP) is acceptable to British South Asian women with PND. • Interventions targeting PND in BSA women should pay particular attention to ways of improving social support, independent coping strategies, role of facilitator, language aspects, childcare and transport provision and using the group discussion techniques (Stories) Dissemination and Impact DM DIGITAL Community engagement day Acknowledgements • All The Participants. • F Creed, Karina Lovell, R. Gater, N Chaudhry, G. Dunn, J. Jackson, W. Waheed, Sarah Khan, Saadia Aseem, Ayesha Waheed, Najia Atif, N Chaudhry, M Husain, Chaudhry, F Naeem, Farah Lunat, Nadeem Gire, Aleen Syed, Jyothi Neelam, Yumna Masood, Atif Rahman, Barbara Tomenson, Asad Bukhari (Dr Rathod, Dr Naeem and “Cry for Change” for the slides) • Funded by UK Medical Research Council. • NIH-R Research for Patient Benefit Programme • Lancashire Care NHS Foundation Trust • University of Manchester.