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A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial

Published online by Cambridge University Press:  25 March 2015

A. J. Daley ,
R. V. Blamey ,
K. Jolly ,
A. K. Roalfe ,
K. M. Turner ,
S. Coleman ,
M. McGuinness ,
I. Jones ,
D. J. Sharp  and
C. MacArthur
A. J. Daley
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
R. V. Blamey
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
K. Jolly*
Affiliation:
Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
A. K. Roalfe
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
K. M. Turner
Affiliation:
Academic Unit of Primary Health Care, University of Bristol, Bristol, UK
S. Coleman
Affiliation:
Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
M. McGuinness
Affiliation:
Perinatal Mental Health Service, The Barberry, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
I. Jones
Affiliation:
Institute of Psychological Medicine and Clinical Neurology, Cardiff University, Cardiff, UK
D. J. Sharp
Affiliation:
Academic Unit of Primary Health Care, University of Bristol, Bristol, UK
C. MacArthur
Affiliation:
Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
*
*Address for correspondence: K. Jolly, Ph.D., Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK. (Email: [email protected])
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Abstract

Background

Postnatal depression affects about 10–15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression.

Method

Women who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization.

Results

A total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a −2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) −4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = −2.26, 95% CI −4.36 to −0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up.

Conclusions

This trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.

Keywords

Depressionexercisepostnatal depressionprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 11 , August 2015 , pp. 2413 - 2425
Copyright
Copyright © Cambridge University Press 2015 

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