Impact of a participatory intervention with women's groups on psychological distress among mothers in rural Bangladesh: secondary analysis of a cluster-randomised controlled trial

Abstract

Background: Perinatal common mental disorders (PCMDs) are a major cause of disability among women and disproportionately affect lower income countries. Interventions to address PCMDs are urgently needed in these settings, and group-based and peer-led approaches are potential strategies to increase access to mental health interventions. Participatory women's health groups led by local women previously reduced postpartum psychological distress in eastern India. We assessed the effect of a similar intervention on postpartum psychological distress in rural Bangladesh.

Method: We conducted a secondary analysis of data from a cluster-randomised controlled trial with 18 clusters and an estimated population of 532,996. Nine clusters received an intervention comprising monthly meetings during which women's groups worked through a participatory learning and action cycle to develop strategies for improving women's and children's health. There was one group for every 309 individuals in the population, 810 groups in total. Mothers in nine control clusters had access to usual perinatal care. Postpartum psychological distress was measured with the 20-item Self Reporting Questionnaire (SRQ-20) between six and 52 weeks after delivery, during the months of January to April, in 2010 and 2011.

Results: We analysed outcomes for 6275 mothers. Although the cluster mean SRQ-20 score was lower in the intervention arm (mean 5.2, standard deviation 1.8) compared to control (5.3, 1.2), the difference was not significant (β 1.44, 95% CI 0.28, 3.08).

Conclusions: Despite promising results in India, participatory women's groups focused on women's and children's health had no significant effect on postpartum psychological distress in rural Bangladesh.

Figure 1. Sample selection procedure for evaluation of the effect of women’s groups on postpartum psychological distress.

From 25,615 births and deaths (‘events’) over the 24 study months in 2010 and 2011 we excluded data from: 17,181 events that did not occur within the SRQ-20 data collection periods; 62 events where it was not possible to conduct an interview due to migration or refusal; 1945 events associated with mothers who were temporary residents in the study area; nine events associated with a maternal death; 100 events associated with mothers who had previously delivered during the SRQ-20 data collection periods, either because of multiple births or through repeated births; 23 mothers due to missing SRQ-20 data. In total, 6275 mothers were included in the final sample.