Developing a Culturally Adapted Cognitive Behavioural Therapy Based Intervention for British Pakistani Mothers with Persistent Postnatal Depression

Abstract of thesisIntroduction. Recent reports indicate inequalities for ethnic minority women in maternal health and a need for tailored maternity services to improve access to care. High rates of postnatal depression among British Pakistani women have been reported. These women tend to suffer from persistent depression and have both, poorer access to and outcomes from evidence based psychosocial interventions, compared to the majority of the population. Trials for Cognitive Behaviour Therapy based interventions for postnatal depression appear to improve clinical outcomes and patient satisfaction. However, no study to date has developed an intervention for this group of women that is culturally sensitive. The overall aim of this thesis was to explore a culturally adapted psychosocial intervention with British Pakistani women with persistent postnatal depression, and use the results of these investigations to develop a culturally adapted cognitive behavioural therapy (CBT) based intervention to the meet the needs of persistently depressed British Pakistani women. Methods. This thesis employed a two-phase design based on the Medical Research Council? s (MRC) complex intervention framework. In the first phase, qualitative interviews were conducted to explore the experiences of British Pakistani women with persistent postnatal depression and the type of help they would find acceptable. These interviews were analysed using framework analysis. Following the findings from phase 1, a culturally adapted CBT based manualised intervention was developed in phase 2, to target the British Pakistani women? s needs and measured participants? satisfaction and engagement. Results. Three emergent themes from qualitative interviews with fifteen British Pakistani women with persistent postnatal depression were identified. These were: 1) causes of persistent postnatal depression; 2) impact of the depression; 3) past help sought and current treatment required for management of persistent postnatal depression. A feasibility study of a culturally adapted CBT based manualised intervention for persistent postnatal depression resulted in high levels of service user satisfaction and engagement. These women found the intervention, both accessible and acceptable for their needs. Fifteen women with persistent postnatal depression took part in the intervention. Significant improvements were found in depression, marital relationships, quality of parenting, and health. Significant improvements in perceived social support were not found. Conclusions. This systematic mixed method approach to the development and testing of a manualised culturally appropriate intervention will provide a framework for those developing culturally adapted interventions for British Pakistani women. A culturally adapted group CBT based intervention was acceptable to British Pakistani women with persistent postnatal depression. A larger trial is currently underway to investigate efficacy of this intervention in terms of reducing depression, and improving social functioning, marital and parental relations, and health.