Postpartum depression: Singaporean mothers find help through phone-based peer support

Studies find peer support, even at the basic level of WhatsApp messages, can help Singaporean mothers guard against the baby blues; trial under way to evaluate large- scale peer support programme using mobile app.

Singapore, 12 April 2021 – Studies from the NUS Alice Lee Centre for Nursing Studies have shown that peer support from trained lay volunteers using mobile technology can help new mothers who are at risk of postpartum depression, and a new trial is under way to investigate the long-term effects on maternal outcomes and the cost-effectiveness of implementing a large-scale peer volunteer programme using a mobile app.

Postpartum depression is a debilitating condition on the rise globally and here in Singapore, especially during the first year after childbirth. It is often described as a period of emotional distress that typically affects a new mother within the first year of childbirth and can interfere with her ability to care for her newborn.

“Postpartum depression is a serious health concern not only for the mother but for the child and the father as well,” said Dr Shefaly Shorey, an assistant professor at the NUS Alice Lee Centre for Nursing Studies (NUS Nursing).

“Early interventions for postpartum depression are therefore important to avoid the many adverse effects the condition brings on child development, and on the mother-child and husband-wife relationships.”

Dr Shorey’s research interests focus on developing and evaluating psychosocial educational programmes in supporting Singaporean parents. She had previously found that parents prefer to receive educational programmes via technology — especially mobile phone applications — and wish to receive continuity of care across the perinatal period, a time found to pose numerous challenges for new parents in Singapore.

Her latest study on the effectiveness of a technology-based peer intervention programme on postpartum depression, completed last year, show a decrease in depressive symptoms three months following childbirth. The findings were published in the Journal of Medical Internet Research.

Randomised Controlled Trial

In the randomised controlled trial, Dr Shorey and her team recruited 138 mothers in the first few weeks after giving birth, who were living in Singapore and were identified as being at high risk for postnatal depression, scoring nine or above on the Edinburgh postnatal depression scale. The average age of the mothers was 32 years and 60% of them were first-time mothers.

Twenty volunteers to provide the mothers with peer support were also recruited by sending mailers to employees of the tertiary hospital where the new mothers had given birth. To be a peer volunteer, the women had to have experienced and recovered from postpartum depression. The volunteers took a half-day training session conducted by a psychiatrist to learn specialised skills in providing support to emotionally distressed mothers. A training booklet was also developed for the session.

“For the first session over the phone, we encouraged the peer volunteers and mothers to break the ice by sharing their postpartum experiences,” said Dr Shorey.

Subsequent sessions, which took place weekly via phone calls or other mobile applications for one month, were more individualised with support rendered by the volunteers based on the needs of the new mothers. For instance, the volunteers would provide emotional support, validate the new mothers’ experiences, tell them about strategies to feel better — such as seeking help from family members or sharing their feelings with their partners, as well as suggest where they could seek professional help if needed.

“We found that new mothers who received the technology-based peer support had a 20% reduced risk of developing postpartum depression, 9% reduced risk of postpartum anxiety, and 8% reduced risk of loneliness at three months postpartum,” said Dr Shorey.

In order to hear from mothers and peer volunteers regarding the strengths and weaknesses of the technology-based peer intervention programme, in-depth face-to-face interviews were conducted.

Flexible Programme

Both mothers and peers had strong praise for the flexibility of the mode of delivery of the programme – mostly via WhatsApp – which was to their convenience and preferences. Mothers felt they had “someone available 24/7” to “listen” to them and peer volunteers felt the “sense of gratification” that they were “able to give back” by helping others.

“The majority of the mothers were appreciative of the extra listening ear and felt they had another friend to talk to and were not alone. They also felt more reassured and had reduced negative feelings after receiving continuous peer support,” said Dr Shorey.

One of the mothers in the study said of her peer support: “Whenever I have issues, she will comfort me…that I’m not the only one going through it, and it’s only normal. It was nice to have somebody additional (there for me) apart from my own family.”

Reception to the intervention pleasantly surprised Dr Shorey and her team as mental illness carries a stigma in Singapore and they were concerned it would dampen Singaporean mothers’ willingness to confide in strangers.

“The non-judgmental support from peers seems to help lessen the stigma often associated with mental illness. When the mothers were told they would be speaking to other mothers who are experienced and have been trained by the experts to serve as peer volunteers, we were surprised that they were very open, and quickly opened up to these ‘listening buddies’. In fact,

they even requested for these volunteers to support them from pregnancy and even asked for the support to be extended beyond one month,” Dr Shorey said.

“There is a need to normalise mental health by educating women and their partners about postpartum depression and encourage their willingness to seek help when they need it, and our study has highlighted the feasibility and effectiveness of training paraprofessionals to provide needed support for new mothers postpartum,” she added.

With new evidence to show that support provided by peer volunteers could be an effective preventive strategy in the Singapore context, Dr Shorey and her team have extended the research project from a single-centre trial to a multi-centre project and are completing work to further evaluate the long-term effects of the programme on maternal and newborn outcomes and its cost-effectiveness.

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