title: Gender-informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: cluster randomised controlled trial.
abstract: OBJECTIVE
  Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum.
  
  
  METHODS
  Cluster-randomised controlled trial.
  
  
  METHODS
  48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24).
  
  
  METHODS
  English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data.
  
  
  METHODS
  WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar.
  
  
  METHODS
  Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules.
  
  
  RESULTS
  In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected.
  
  
  CONCLUSIONS
  WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare.
  
  
  BACKGROUND
  ACTRN12613000506796; Results.
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Rowe
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Wynter
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Thach
authors.initials: T
authors.lastname: Tran
authors.affiliation: Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Paula
authors.initials: P
authors.lastname: Lorgelly
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Amir
authors.affiliation: Victorian Department of Education and Training, Melbourne, Victoria, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Proimos
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Ranasinha
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia Department of Paediatrics, Centre for Community Child Health, The Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Jordana
authors.initials: J
authors.lastname: Bayer
authors.affiliation: Parenting Research Centre, Melbourne, Victoria, Australia.
authors.forename: Warren
authors.initials: W
authors.lastname: Cann
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis*; D001315:Australia; D005191:Family Characteristics; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control*; D010298:Parity; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011644:Puerperal Disorders / Q000517:prevention & control*; D057566:Self Report; D012720:Severity of Illness Index
keywords: PRIMARY CARE; father-inclusive; postnatal common mental disorders; prevention; psychoeducation