PRISM (Program of Resources, Information and Support for Mothers): a community-randomised trial to reduce depression and improve women's physical health six months after birth [ISRCTN03464021]

BACKGROUND: In the year after birth one in six women has a depressive illness, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support, more negative life events, and poorer physical health and see factors contributing to depression as lack of support, isolation, exhaustion and physical health problems. Fewer than one in three seek help in primary care despite frequent health care contacts. METHODS: Primary care and community-based strategies embedded in existing services were implemented in a cluster-randomised trial involving 16 rural and metropolitan communities, pair-matched, within the State of Victoria, Australia. Intervention areas were also provided with a community development officer for two years. The primary aim was to reduce the relative risk of depression by 20% in mothers six months after birth and to improve their physical health. Primary outcomes were obtained by postal questionnaires. The analysis was by intention-to-treat, unmatched, adjusting for the correlated nature of the data. RESULTS: 6,248 of 10,144 women (61.6%) in the intervention arm and 5057/ 8,411 (60.1%) in the comparison arm responded at six months, and there was no imbalance in major covariates between the two arms. Women's mental health scores were not significantly different in the intervention arm and the comparison arm (MCS mean score 45.98 and 46.30, mean EPDS score 6.91 and 6.82, EPDS ≥ 13 ('probable depression') 15.7% vs. 14.9%, Odds ratio(adj )1.06 (95%CI 0.91–1.24). Women's physical health scores were not significantly different in intervention and comparison arms (PCS mean scores 52.86 and 52.88). CONCLUSION: The combined community and primary care interventions were not effective in reducing depression, or in improving the physical health of mothers six months after birth

PRISM (Program of Resources, Information and Support for Mothers) Protocol for a community-randomised trial [ISRCTN03464021]

BACKGROUND: In the year after birth one in six women has a depressive illness, and 30% are still depressed, or depressed again, when their child is 2 years old, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support overall, more negative life events, and poorer physical health. Their perceptions of factors contributing to depression are lack of support, isolation, exhaustion and physical health problems. Fewer than one in three affected women seek help in primary care despite frequent contacts. METHODS/DESIGN: PRISM aims to reduce depression and physical health problems of recent mothers through primary care strategies to increase practitioners' response to these issues, and through community-based strategies to develop broader family and community supports for recent mothers. Eligible local governments will be recruited and randomised to intervention or comparison arms, after stratification (urban/rural, size, birth numbers, extent of community activity), avoiding contiguous boundaries. Maternal depression and physical health will be measured six months after birth, in a one year cohort of mothers, in intervention and comparison communities. The sample size to detect a 20% relative reduction in depression, adjusting for cluster sampling, and estimating a population response fraction of 67% is 5740 × 2. Analysis of the physical and mental health outcomes, by intention to treat, will adjust for the correlated structure of the data

Social media used as a health intervention in adolescent health a systematic review of the literature

Objective: Adolescents are known to be high users of social media, and social media is beginning to be used in health care. The primary objective of this review was to determine the current state of play on the use of social media as a health intervention in addressing the health of adolescents

Developing a systematic literature review on the use of social media as a health intervention in adolescent health: A case study

Shaw, JM ORCiD: 0000-0001-9416-787X; Williamson, MJ ORCiD: 0000-0002-8504-5851A systematic literature review provides the basis for identifying consistency in research processes, quality of research methodology, current knowledge, and gaps in knowledge. This information is important as it provides researchers with guidance on a particular area of knowledge, including what worked well, what did not work well, and the direction that future research may take. A systematic review is different to other forms of literature reviews, and this difference is reflected in the method. The following case study looks at the process undertaken when systematically reviewing the literature on “the use of social media as a health intervention in adolescent health.” In particular, the case study highlights the importance of clearly identifying the topic under review, the use of a tested or proven tool to assess the literature, and the dissemination of the findings, that is, writing up the review so that others may understand and if required replicate the study. The case study provides an opportunity to reflect on the processes of a systematic literature review with examples to demonstrate that process

EPDS and SF-36 mean scores two years after birth for selected pre-specified subgroups.

<p>*Scales adjusted for age/sex distribution of PRISM population, factor loadings and standard deviation using Australian National Health Survey values.</p><p>ABS. National Health Survey. SF-36 Population Norms Australia: Australian Bureau Statistics, Commonwealth of Australia Catalogue No. 4399.0; 1997.</p

Schematic overview of conceptual thinking behind PRISM.

<p>Schematic overview of conceptual thinking behind PRISM.</p

Trial flow diagram.

<p>Trial flow diagram.</p

Women's reports two years after birth about information received, primary care support, friendships, community support and partner support in intervention and comparison communities.

<p>[Difference: −0.034,SE_adj: 0.06, p-value: 0.58].</p

Response fractions and primary outcomes at two years in intervention and comparison communities.

<p>Response fractions and primary outcomes at two years in intervention and comparison communities.</p