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The Effect of Peer Support on Postpartum Depression: A Pilot Randomized Controlled Trial
The volunteer coordinator twice telephoned peer volunteers who did not return their activity logs. Sixteen of the 20 activity logs were returned, an 80% response rate. Peer-volunteer contacts were assessed and further subdivided into connections (actual peer–mother interactions, such as speaking on the telephone) and attempted connections (unsuccessful efforts to connect, such as leaving a telephone message on an answering machine). The 16 activity logs showed that, during the 2 months monitored, peer volunteers logged 5 or more actual connections (mean 5.4, SD 3.5) and 5 attempted connections (mean 5.6, SD 2.6) for most mothers. The peer volunteers initiated most of the telephone contacts, with only 2 mothers initiating an interaction. The mean duration of a telephone connection was 34.4 minutes (SD 20), with a range of 6 to 90 minutes; 12 (75%) peer–mother relationships actively continued past the 2 months monitored. Finally, correlations showed that the number of peer-volunteer contacts was not significantly related to depressive symptomatology at the 4-week (r = 0.26) or 8-week (r = 0.45) assessments. Interestingly, data from the activity logs suggest that 37.5% of peer volunteers referred a mother to a professional health service.
Sixteen out of 20 participants (80%) evaluated their peer-support experience, with 87.5% (n = 14) indicating that they were very satisfied. Most mothers felt that their peer volunteer provided them with emotional, informational, and appraisal support; understood them and was trustworthy; and had a positive health effect (Table 4). All 16 peer volunteers who completed the PVEQ were satisfied with their experience and would volunteer again (Table 5).
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Table 4 Summary of maternal perceptions of peer support from a sample
of items
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Subscale
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Domain
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Maternal responses to sample items
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Strongly agree (%)
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Supportive
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Emotional support
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My peer listened to me talk about my concerns
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16 (100)
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|
interactions
|
|
Accepted me for who I was
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15 (94)
|
|
|
Appraisal support
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Told me I did something well
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15 (94)
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|
|
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Gave me feedback on how I was doing
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14 (88)
|
|
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Informational support
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Provided me with practical information
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15 (94)
|
|
|
|
Assisted me to solve my problems or concerns
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15 (94)
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Relationship
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Perceived peer
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I felt free to talk about almost everything with my peer
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14 (88)
|
|
qualities
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responsiveness
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My peer was dependable
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14 (88)
|
|
|
|
I felt accepted by my peer
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14 (88)
|
|
|
|
My peer understood my point of view
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14 (88)
|
|
|
|
I felt comfortable sharing with my peer
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14 (88)
|
|
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Extent of interdependence
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I felt close to my peer
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14 (88)
|
|
|
|
My peer invested time to help me
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15 (94)
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|
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Sentiment
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My peer pressured me to change
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0 (0)
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|
|
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My peer was critical of me
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0 (0)
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|
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Peer qualities
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My peer was interesting and enjoyable to talk to
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15 (94)
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|
|
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My peer seemed anxious when talking to me
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1 (6)
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|
|
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Support from my peer helped me:
|
|
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Perceived
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Social integration
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Feel less isolated
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15 (94)
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benefits
|
|
Feel less left out
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15 (94)
|
|
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Stress and coping
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Feel more in control of my situation
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13 (81)
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|
|
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Feel less worried
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13 (81)
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|
|
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Respond better to stressful situations
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14 (88)
|
|
|
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Compare myself to similar others
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12 (75)
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|
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Social construction
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Feel more confident
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13 (81)
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|
|
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Feel more positive about myself
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13 (81)
|
|
|
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Set realistic goals
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12 (75)
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Satisfaction
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Access
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I was able to talk to my peer when I needed to
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13 (81)
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Convenience
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I liked the support over the telephone
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15 (94)
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|
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Perceived quality
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My peer was competent
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15 (94)
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|
|
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There is nothing I would have liked done differently
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15 (94)
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Table 5. Summary of peer-volunteer perceptions of their experiences
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Positive (”yes”) responses
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n (%)
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1. Do you think the 4-hour training session prepared you for your peer
volunteer role?
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14 (87.5)
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2. Would you have liked on-going educational sessions?
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14 (87.5)
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3. Do you think peer volunteers require some sort of supervision?
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14 (87.5)
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4. Should peer volunteers be evaluated to ensure a high quality of support?
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13 (81.3)
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5. Did you ever feel uncomfortable while supporting a mother?
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4 (25)
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6. Did you ever feel disappointed while supporting a mother?
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8 (50)
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7. Did you refer a mother to professional health services?
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6 (37.5)
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8. Did participating the program interfere with your life?
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2 (12.5)
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9. Did participating the program help you grow as an individual?
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16 (100)
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10. If you could do it over again, would you become a peer volunteer?
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16 (100)
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Discussion
In this pilot trial, 15% of mothers who received peer support had EPDS scores > 12 at the 8-week assessment, compared with 52.4% of mothers in the control group. The significant effect of peer support on depressive symptomatology at the 4- and 8-week assessments remained even after baseline demographic variables such as age, education, and income were controlled. Equally important is the finding that significantly more mothers in the control group had EPDS scores > 9 at both assessment periods. Thus, peer support decreased not only the number of mothers who were potentially experiencing major PPD but also those with probable minor PPD. While no significant group differences were found in relation to maternal self-esteem, child-care stress, and loneliness, positive trends favouring the experimental group were demonstrated. These findings provide further evidence that the outcomes are amenable to supportive interventions. However, because there was insufficient power to detect group differences, a larger trial is required to ascertain the true effects of these secondary outcomes.
The frequency and occurrence of peer-volunteer interactions were not correlated with EPDS scores at the 8-week assessment, suggesting that a standardized peer-support intervention is not necessary. This finding is congruent with those of Dennis (63) and Israel (80), who reported that it is not the quantity but the quality of social interactions and relationships that is most strongly associated with health outcomes. Another explanation for this finding may be that the active ingredient was not the actual receipt of peer support but the perception that a peer volunteer would be available to talk, if necessary. Research has indicated that perceived support may have a stronger influence on specific health outcomes than actual, enacted support (81).
Consistent with previous telephone-based supportive interventions for new mothers (79), both participants and peer volunteers evaluated their peer-support experience positively, although the extent to which social desirability influenced maternal and peer-volunteer evaluations is unknown. However, these findings indicate that the main pilot trial result—that telephone-based peer support may significantly decrease depressive symptomatology among some mothers—is an important preliminary clinical finding that warrants further research. Such future research should include a larger randomized controlled trial that assesses depressive symptomatology to at least 6 months postpartum in a heterogeneous sample.
Funding and Support
This research was supported by a postdoctoral research fellowship from the Canadian Institutes for Health Research (CIHR).
Acknowledgements
I thank the research team of Margaret Gander, Patricia Whitehead, Linda Bachmann, Alana Boucher, Terry Gust, Pam Munro, Tina Regehr, Phyllis Randle, and Lorraine Friesen; the research liaison public health nurses Heidi Beckerleg, Yvette Szabo, Mona Taylor, and Linda Winner; and the volunteer coordinators Joyce Locht and Katherine Preston.
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Manuscript received April 2002, revised, and accepted July 2002.
1. Assistant Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario.
Address for correspondence: Dr C-L Dennis, Faculty of Nursing, 50 St George Street, Toronto, ON M5S 3H4
e-mail: cindylee.dennis@utoronto.ca
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