Title: Using expressive writing interventions to promote health in women after birth
Funder: Department of Health (England)

Abstract: Background Promoting postnatal health is a recognised clinical priority. National Service Frameworks state ‘improving the health and welfare of mothers and their children is the surest way to a healthier nation’[1]. Psychological problems such as postnatal depression or anxiety disorders can have profound effects on women and families. NICE guidelines therefore emphasise the need for intervention but draw attention to the lack of evidence-base[2]. Disclosing personal thoughts and feelings through expressive writing is associated with improved health in many other groups. Reviews show expressive writing can have positive effects on psychological and physical health, general functioning, health service use, and is beneficial during periods of stress[3,4]. Expressive writing may therefore be particularly helpful after birth but it is important this intervention is tailored to postnatal women, properly evaluated, and problems of uptake in hard-to-reach groups identified before such interventions are implemented. Aims Our research aims to evaluate expressive writing intervention for postnatal women using a randomised controlled trial to compare an expressive writing intervention, a control intervention, and normal care for postnatal women. This study aims to: 1. Evaluate the effect of expressive writing on postnatal psychological health, physical health and quality of life. 2. Evaluate the effect of expressive writing on use of healthcare services and satisfaction with healthcare services. 3. Evaluate the acceptability of expressive writing to postnatal women. 4. Examine the effect of socio-demographic factors and ethnicity on uptake of the intervention. Plan of investigation This project will determine the efficacy and acceptability of expressive writing to promote health in postnatal women using a randomised controlled trial. The sample will consist of 321 women recruited six weeks after having a baby. Women will complete baseline measures then be randomly allocated to an expressive writing group, control intervention group, or normal care. The expressive writing group will write about stressful issues that arose during or after birth. The control intervention group will write about time management. In both these groups women will be expected to write for 15 minutes a day on three consecutive days. The normal care group will receive postnatal medical care with no psychotherapeutic intervention. Primary outcomes are changes in psychological and physical health and quality of life. Secondary outcomes are changes in healthcare service use and satisfaction. These outcomes will be measured before, 1-month after and 6-months after the intervention. Women in the expressive writing group will be followed-up at the end of the study to obtain their views and evaluations of expressive writing. Potential impact This study potentially has a wide-ranging impact on health and healthcare. Unlike interventions that have to be delivered by healthcare practitioners, expressive writing interventions can be adapted to be freely provided and widely accessed via the internet. Obviously such interventions need to be adapted to the target population and properly tested before such wide-spread implementation. However, if proven to be of benefit to women this intervention could have a marked effect on maternal mental health in the UK, and subsequently on healthcare service use. Through these factors, the potential economic impact of the expressive writing intervention is also significant. From the NHS perspective, this type of intervention is simple, cost-effective, low-risk and can be incorporated into normal postnatal care through the provision of workbooks or information on the internet. The provision of preventative or low-level treatment via the internet reduces cost and pressure on services. This expressive writing intervention would be immediately available at the end of the project and could be fast-tracked into both local and national healthcare service policies. Dissemination and user-involvement could encourage uptake of the intervention without need for referral from healthcare services.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;REPRODUCTIVE HEALTH AND CHILDBIRTH