1. An Evaluation of a Peer-Led Support Group for
Women with Postpartum Mood Disorders
Betty-Shannon Prevatt, MA, Pressley Cox, Sarah L. Desmarais, PhD, and Caroline Pence
North Carolina State University, Postpartum Education and Support
The Present Study
Postpartum Education and Support (PES) is a 501c3 non-profit
organization in Raleigh, NC whose mission is to offer support and
resources to women experiencing postpartum mood disorders and
their healthcare providers. Moms Supporting Moms (MSM), the
signature program offered by this peer-support group, was
developed to increase social support and destigmatize postpartum
mood symptoms and has been running since 1998. The group
meets weekly after-hours in the large waiting room of an OBGYN
practice. MSM provides a judgment-free support network led by
recovered moms who have been trained in group dynamics.
Professionals with expertise in postpartum mood disorders (PPMD)
are also present at each group to co-facilitate.
Fliers promoting PPMD awareness generally, and the MSM program
specifically, are provided in the discharge packet of every woman
who delivers at Rex Hospital, approximately 5,600 women each
year (A. Wolf, personal communication, January 19, 2015). Fliers
also are distributed through many Raleigh-area OBGYN practices
and pediatrician offices. Despite its success, there has been limited
evaluation of the group’s effectiveness. In addition to evaluating
changes in PPMD symptomatology, evaluating women’s perceptions
of the program is critical to understanding the effectiveness of MSM.
The present study represents Phase I of a two-phase evaluation of
the MSM program. In this phase, we were interested in examining
characteristics of women who have taken part in the MSM group to
describe the population and their treatment needs.
Methods
We examined intake data for 80 participants attending the MSM
peer-support group between January 2013 and February 2015. At
program intake, participants completed a demographic
questionnaire querying their age, number of children, race, and
marital status. These demographic characteristics were examined
along with symptom severity as measured by the Edinburgh
Postnatal Depression Scale (EPDS) (Cox, Holden, & Sagovsky,
1987). Briefly, the EPDS is comprised of 10 questions and can be
completed in less than 10 minutes. Responses are scored 0-3
according to increased (from none to high) symptom severity. The
EPDS total scores, thus, can range from 0 to 30, with variations in
the clinical cutoff for diagnosing postpartum depression ranging from
9-13. Frequency of suicidal ideation was measured using question
10 of the EPDS, with responses ranging from “none” to “yes, quite
often.”
All study procedures were approved by the Institutional Review
Board at North Carolina State University.
Discussion
Results show clinically significant levels of PPMD in this community
sample of women and revealed differences in symptomatology as a
function of participant age and number of children. Given the
severity of depressive symptomatology and prevalence of suicidal
ideation in this sample, it appears that the MSM program may be a
valuable resource for women struggling with PPMD. However, the
relative homogeneity of participants indicates that the program is
only meeting the needs of a narrow group of women. Thus, there is
a need to adapt the group or improve the reach by more effectively
marketing to a broader group of women who may be equally as
vulnerable but not yet participating the program.
The small sample size represents a limitation of the evaluation
which necessitated dichotomizing some demographic characteristics
to meet the assumptions for statistical analyses. Also, the
distribution of the suicidal ideation scale scores was skewed. Phase
2 of the evaluation will build on the present findings by examining
post-group outcomes and participant perceptions.
Results
Participant Characteristics
Participants were predominantly white (87%) and married (84%).
Most of the women were aged 31-40 (56%) while 27% were aged
26-30 and 12% were aged 21-25. The majority had only one child
(60%) while 29% had two children. The mean EDPS total score was
17.11 (SD = 4.41, range = 5-26), representing diagnostic levels of
symptomatology.
Results
Suicidal Ideation
Approximately one-third (38%) of participants indicated some
suicidal ideation in the past seven days.
References
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal
depression: Development of the 10-item Edinburgh Postnatal
Depression Scale. British Journal of Psychiatry, 150, 782-786.
21.8
16.3 16.18
18.67
17.12 17.08 17.03
13.36
15.64
19.1
10.00
15.00
20.00
25.00
Age (N) Race (N) Relationship Status
(N)
Number of Children
(N)
Clinical Severity
MSM facilitators encourage women who score ≥12 on the EPDS or
who indicate any suicidal ideation on question 10 to seek
professional mental health services. Most participants (96%) met the
lowest cutoff suggesting postpartum depression with an EPDS score
≥9, while 84% met the least inclusive cutoff criteria by scoring ≥13
(see Figure 1). The only participant characteristic related to meeting
cutoff criteria was number of children (X2 (1) = 6.58, p=.010,
contingency coefficient = .29, p = .010).
Table 1 presents the mean EPDS total scores by participant groups.
T-tests revealed that women with one child demonstrated
significantly lower levels of depressive symptomatology than women
with more than one child t(71) = -3.57, p = .001. Group differences
for age were examined via an ANOVA, which was significant, F(2,
69) = 7.78, p = .001. Post hoc analysis showed that women aged
18-25 had significantly greater EPDS scores than women who were
aged 26-30 (p = .001) and women aged 31-45 (p < .001). There
were no differences in scores by relationship status or race.
Table 1. Mean Edinburgh Postnatal Depression Scale Scores
1.10
0.30
0.61
1.30
0.63
0.54
0.64 0.64
0.43
0.87
0.00
0.50
1.00
1.50
Age (N) Race (N) Relationship Status
(N)
Number of Children
(N)
Table 2 presents the mean suicidal ideation scores by participant
groups. Again, group differences for age were examined via an
ANOVA, which was significant, F(2, 68) = 2.98, p = .057. Post hoc
analysis revealed that the youngest women had significantly greater
suicidal ideation than women who were aged 26-30 (p = .019).
There were no differences between the other age groups, nor as a
function of the other participant characteristics.
Table 2. Mean Suicidal Ideation Scores
4.2%
12.2%
83.6%
≤ 8: minimal symptoms
9-12: cutoff range
≥ 13: PPMD likely
Figure 1. Proportion of Participants Meeting Clinical Cutoffs
Introduction