‘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.