SUMMIT

SUpporting Mothers’ Mental health with Interpersonal Therapy: A large multi-site study evaluating the impact of Group Interpersonal Psychotherapy (IPT) In Lebanon and Kenya

What is postnatal depression?

Postnatal depression is a depressive illness which can affect any woman who has had a baby. Symptoms can include persistent low mood, lethargy, trouble sleeping, difficulty bonding with the baby, and frightening thoughts such as wanting to hurt the baby.

Women with depression often struggle to respond to their children’s needs. Research shows that as a result of this, children of women with postnatal depression (PND) have poorer learning, or cognitive development, and more emotional and behavioural problems as they grow up. These issues can be exacerbated by other challenges faced by families living in low- and middle-income countries and can further negatively affect children’s development.

What is group interpersonal therapy (g-IPT)?

Group-Interpersonal Therapy is a structured and time-limited talking therapy treatment for depression in adults. With its basis of psychoanalysis and attachment theory, g-IPT focuses on interpersonal relationships, life transitions, and the therapeutic alliance. It believes that depression is triggered and worsened by interpersonal problems and adversities, such as grief, interpersonal disputes, role transitions, and loneliness and social isolation. It therefore works on identifying how the onset of current depressive symptoms relates to interpersonal problems, and provides skills which can aid in more effective management of said problems.

What is the SUMMIT trial?

The study consists of two phases; feasibility study and a large-scale randomised control trial. Teams in Kenya and Lebanon will work with the team in the United Kingdom to explore the community and cultural vue on maternal depression, and how to access help may be affected by local factors. A culturally adapted version of g-IPT will then be developed to be delivered to mothers in both countries.

The feasibility study portion of the trial will involve a Randomised Control Trial (RCT) comparing the effects of g-IPT to those of High Quality - Standard Care (HQ-SC). Participants will be randomly assigned to receive either g-IPT or HQ-SC. Participants in the g-IPT arm of the trial will undergo an 8-session WHO-endorsed therapy, with each session lasting 90 minutes. Participants in the HQ-SC arm will receive an illustrated guided self-help manual, delivered over 2 sessions, focused on stress management and coping with adversity. Following the feasibility study, the protocol will be scaled up to large scale randomised control trial across multiple sites in both countries.

Trial Objectives

Develop an understanding of how postnatal depression is perceived by local communities
Use this understanding to develop an adjusted g-IPT in partnership with experienced local practitioners
Use local and community intelligence and policies to identify the best solution for screening women for PND
Train local workers to deliver the newly adapted g-IPT
Carry out a feasibility RCT to evaluate the critical elements of g-IPT
Learn about and improve sustainable care pathways for postnatal depression and g-IPT treatment in partnership with local communities, practitioners, and policy makers, as well as develop a toolkit to support training and implementation in other countries.

Feasibility study: data collection

Participants will be contacted 8, 13 and 24 weeks post-baseline to complete a set of outcome measures. The primary outcome measure is the Patient Health Questionnaire used to assess the presenting severity of depression. Participants will also be assessed on their family circumstances, early development, physical health and sleep patterns of the baby, anxiety and depression, sleep functioning, general health and alcohol use, breastfeeding patterns, social isolation and quality of life, and relationship satisfaction. A further economic analysis will evaluate the monetary value of IPT treatment.

What were the findings?

The trial is currently underway.

SUMMIT

What is postnatal depression?

What is group interpersonal therapy (g-IPT)?

What is the SUMMIT trial?

Trial Objectives

Feasibility study: data collection

What were the findings?

Chief Investigator

Principal Investigators

Trial Statistician

Trial Coordinators