This story reports on a small study suggesting that peer counseling by telephone can be helpful for some mothers experiencing postpartum depression. The story is thoroughly reported. It includes perspectives from two experts not affiliated with the research, and a good explanation of the study’s limitations. But there are a few areas where some extra details would have made the story stronger. For example, the story falls short in describing costs and potential harms of the intervention. We’d also add that in any study with no control group, it’s important to evaluate all aspects of the study that might explain the positive results. Did the women have any contact — for example, with other doctors or health professionals — that might have led to a reduction in symptoms? The story also could have done more to explain what happens to women with postpartum depression who aren’t treated. Would most of them get better with time? The study may not prove much if the women would be expected to get better on their own.
The American Psychiatric Association estimates that 9 to 16 percent of first time mothers experience postpartum depression (PPD), defined as a “serious mental health problem” marked by a prolonged period of emotional disturbance that affects the ability to function normally. An outside expert quoted in the story calls it the most common complication of childbirth, and for women who have previously experienced PPD, the rate of recurrence is as high as 40 percent. Compounding the problem is that it’s hard even for professionals sometimes to tell the difference between PPD and short-term sadness owing to stress and sleeplessness when a newborn is in the home. Thus, the prospect of having a another way to get inexpensive, accessible, and effective care to millions of women is newsworthy.
We want to rule this satisfactory. The story notes that the peer phone counseling is run by volunteers with nurses on call, and is thus cheaper than professional counseling, which is “expensive.” But we need some kind of quantification to know what the story means by “low-cost” vs. “expensive.”
The story makes a good effort to quantify the effects of peer phone counseling, but the outcomes reported could be clearer. The story tells us that the women were “depressed” at the beginning of the study, but that only 32 percent were “at risk for depression” by the middle of the study. We also learn that 60 percent of the mothers had “low depression scores” at the study’s midpoint and that this percentage rose to 75 percent at the end. We’re not sure if the story is giving us an apples-to-apples comparison here. We have a baseline state of “depression,” but the improvement is measured in women “at risk of depression” and who had “low depression scores.” The story should have used the same metric to document depressive symptoms throughout the study, and defined what is meant by “at risk of depression” and “low depression scores.”
Furthermore, since there was no control group in this study, the story would have done well to explain whether women would naturally be expected to improve with time and by how much. That would help us assess whether the counseling was more effective than just waiting.
The intervention could be harmful, but the story does not address that possibility. The peer counselors might be less capable than professionals of detecting suicide risk, for example. Or, the counseling might provoke additional symptoms such as excessive anxiety.
The story clearly notes that the study was small, lacked a control group, and had “several” women drop out. It also quotes more than one outside source, one of whom notes that the results align with previous studies that show benefits for peer counseling. That’s sufficient for a satisfactory rating.
PPD affects large numbers of women, by many accounts, And it quotes experts affirming its seriousness and impact. No mongering here.
The story quotes two outside sources and notes explicitly that they were not involved in the current study. Gratifying!
The story implies that the major alternative for managing PPD is in-person counseling from a mental health professional. It also notes that many of the women had previously received treatment with medication, suggesting that this is an option for PPD.
This is a borderline call where we’ll give the story the benefit of the doubt. The story does not explicitly address availability of peer counselors, although it implies that they are not generally available for PPD. And the story does give enough detail to help the reader understand what would be necessary to create such a system of peer counselors. A comment about availability of peer counseling for other health issues would have been useful.
The story refers to previous studies suggesting the value of peer counseling. It’s clear that this is not the first such study.
Because the story includes interviews with independent experts, we can be sure it did not rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (1)
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Judith Ronat M. D.
March 2, 2015 at 10:19 amIf I remember rightly, Colin Murray Parkes wrote about benefits of telephone follow up to bereaved people decades ago. I remember reading one of his books about this, I think in a Penguin paperback. I think phone support is helpful in many situations, but perhaps it isn’t used enough because one cannot charge for it.
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