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Interesting postpartum depression study results reported in the Guardian, but have they actually been published?

Rating

2 Star

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Therapy ‘has long-term benefits for mothers with depression’

Our Review Summary

This is a news story about new findings indicating long-term benefits of cognitive-behavioral therapy for postpartum depression.

We can’t find any evidence that the findings this news story is based upon have been published yet, which is problematic–readers who want to learn more are left to fend to themselves. It appears, instead, that the findings were presented at the UK’s Royal Economic Society Annual conference in April, and perhaps will be published soon. But it’s far from clear where this story is getting its information from beyond a media briefing.

Now for what we do know: In 2008, a large controlled trial showed that a relatively simple form of cognitive-behavioral therapy for mothers diagnosed with depression was effective compared to the control group. In 2015, researchers checked in with the mothers to see how their children were doing. Now, in 2017, it appears, they’ve followed up to see how the mothers are doing–and it appears they’re doing well, still benefiting from the intervention. However, the data on this aren’t out yet.

 

Why This Matters

This was a relatively low-intensity intervention (peers/community health workers delivering a modified CBT approach, called the Thinking Healthy Programme), used at a community level, designed to be used in a low-resource country.

For this reason, if this kind of program really does decrease maternal depression over the long-term, it could be very important for women all over the world. But news stories should not rush to report findings that haven’t been vetted yet.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

We were glad that this short story mentioned the societal cost estimate for depression but still find it lacks any “cost” for the therapy under discussion.

For the clinical trial, the researchers used an existing system of Lady Health Workers who are specially trained to do the intervention, so the cost would be whatever it cost to add this training and time to their work. (Likely minimal.)

So, we think the story should have added a line or two acknowledging that it was a relatively affordable intervention where it was implemented–in Pakistan–but is likely to be of widely varying costs depending on where it’s used. In the U.S., for example, cognitive behavioral therapy typically requires 8-12 weeks of visits to a professional who charges between $180 and $250 per hour in the United States, according to Consumer Reports. Some of this might be covered by some insurance.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Here’s what the story said about benefits. The figures reported are in italics, sometimes in numbers and sometimes as percentages.

“The study, one of the largest randomised control trials to be held in the developing world, followed women diagnosed with depression mid-pregnancy in 40 communities in rural Pakistan. Within a year, more than half of the women in a control group (58%) were still depressed, whereas only a quarter of the mothers who had been treated with CBT reported depression.

“Returning to the women and their children seven years later, researchers found that the treated mothers were still significantly less likely to be depressed than the control group.”

The first paragraph of this passage was detailed and useful. But, considering that this story is all about the 7-year follow-up, there was not enough information on what was measured (in the second paragraph). What does “significantly less likely” mean, numerically? Had that been expressed in numbers or percentages, we’d have likely rated this Satisfactory.

Does the story adequately explain/quantify the harms of the intervention?

Not Applicable

The story does not make any statement on the risks or drawbacks of this intervention. However, given the relatively low-risk profile of cognitive-behavioral therapy, we’ll rate this N/A.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does provide some important details on the initial study:

The study, one of the largest randomised control trials to be held in the developing world, followed women diagnosed with depression mid-pregnancy in 40 communities in rural Pakistan.

However, it doesn’t give us adequate information about the follow-up study on maternal outcomes. It states that it is based on research led by Sonia Bhalotra, of the Institute for Social and Economic Research, ISER, at the University of Essex, and that’s about it.

We could not find any publication of this presumably new research by Bhalotra. What we did find was a media briefing indicating that this research was recently presented at a conference–which indicates it should be considered preliminary until published. This point should have been stressed in the news story.

Does the story commit disease-mongering?

Satisfactory

There was no disease mongering. We were also pleased that the story talked about multiple impacts on patients with this diagnosis, including their financial health.

Here is what the researcher said about the patients who responded to treatment: “Their mental health has improved, their financial situation and their empowerment over their lives, and undoubtedly the way they interact with their children.”

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story does not quote anyone independent of this study; this would have been very useful to include considering this is unpublished data (as far as we can tell).

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions that people are often prescribed drugs for depression, and that CBT may be a better alternative.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story didn’t address availability.

As explained in the original clinical trial, the researchers used an existing system of Lady Health Workers who are specially trained to do the intervention, making the treatment available in an area where it normally wouldn’t be.

But even in nations with more resources, spotty insurance coverage and lack of providers limit access to this type of care. The story should have at least touched up on the availability issue. This is an area an independent source likely could have given some context on.

 

Does the story establish the true novelty of the approach?

Satisfactory

The story established novelty in this way:

While studies have highlighted the short-term benefits of CBT, until now question marks have been raised about whether it can have long-term effects.

Does the story appear to rely solely or largely on a news release?

Not Applicable

We couldn’t find a news release per se, so we’ll rate this N/A. But we did find this media briefing. The story includes quotes not found in the briefing.

Total Score: 3 of 8 Satisfactory

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