Early Psychosocial Stimulation Program for Children of Depressed Mothers (LTP)

October 9, 2020 updated by: Pakistan Institute of Living and Learning

Early Psychosocial Stimulation (LTP) Program for Children of Depressed Mothers: An RCT

Aim:

To assess the feasibility of provision of an early psychosocial stimulation programme for the children of depressed mothers and to determine its effect on, mothers depression , mothers' knowledge and practices of childrearing and on children's development.

Hypothesis:

Primary hypothesis:

Mothers attending the psychosocial stimulation program will have significant improvement in the level of depression as compared to the mothers who are on the waiting list.

Secondary hypothesis:

Children of mothers having the intervention will have significantly better growth than the children of mothers who do not have the intervention.

Design:

Randomised controlled trial.

Setting:

An urban slum in a township in Karachi.

Participants:

A total of 130 randomly selected depressed mothers in the intervention group and a total of 130 mothers in the waiting list control group.

Interventions:

Weekly LTP groups for the first eight sessions and two fortnightly sessions. Parenting issues will be discussed with the mothers and play activities will be demonstrated with the children using LTP and homemade materials.

Main outcome measures:

Mothers scores on EPDS & HAM D , Parenting stress as measured by PSI-SF and mothers' knowledge and practices of child rearing measured by questionnaires. Children's height, weight, head and arm circumference.

Study Overview

Status

Completed

Detailed Description

Research findings suggest that maternal depression affects infant development and growth through multiple processes. Disability due to depressive symptoms (such as fatigue, poor concentration, loss of interest) is likely to affect child-care abilities directly, while impaired social functioning is likely to have indirect consequences through lack of support in childcare. Disturbances in mother-infant relationship in depressed mothers (Cooper 1999) negatively influence the infant's development. The Community-Based Multimodal Psychosocial Intervention LTP has been designed to target these processes and include a supportive component, an educational component (nutritional and healthcare advice)and a parenting programme (Childs psychosocial development through mother-infant play providing stimulation, and support for exploration and autonomy for the infant (Rahman et 2008). The objective will be to help mothers feel supported, empowered and confident about their parenting abilities, and through this process positively influence their mood. Rather than the directive approach of the medical model, health workers will be trained to adopt a more patient-centered approach, tailoring the components according to individual needs of the patient.

Further qualitative testing of the intervention will take place, This will help us to further refine the intervention package, and understand the underlying mediators (maternal mood state, levels of social support, appropriate care, etc) and moderators (education, socioeconomic status) of intervention. Some or all of these important mediators/moderators will then be later studied in detail. Detailed documentation, protocol and training-programme development for the intervention will take place in this trial.

We plan to have this intervention delivered over a three months period. Initially we will deliver weekly sessions in the first 8 weeks of recruitment. This will be followed by two fortnightly sessions in the third month. Thus making a total of 10 sessions. Each session would take up to one hour. These group sessions will be carried out at the health centre.

The trial will give an opportunity to test if the proposed intensity and duration of the intervention are acceptable to participants and to set into place mechanisms to ensure a high level of consistency with which the intervention is delivered. Feedback of performance will give an idea of how frequently refresher training is to be provided and the intervention delivery monitored. Outcome measures for the main trial and cost-effectiveness will also be tested during this phase.

The proposed pilot trial design is a single-blind study, with two parallel groups randomised individually.

Study Type

Interventional

Enrollment (Actual)

260

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Sindh
      • Karachi, Sindh, Pakistan
        • Community Setting

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years to 40 years (ADULT, CHILD)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

• All Mothers of children aged between 6-30 months having maternal depression

Exclusion Criteria:

  • Subjects will not be included in the trial if they have a diagnosed medical condition or significant physical or learning disability, postpartum or other form of psychosis, or are currently under psychiatric care.
  • Mothers of children with any serious medical or psychiatric illness will also be excluded.
  • The age range of mothers for inclusion in the study will be 16 to 40 years, and all subjects should intend to stay in the study area for at least another 6 months.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: SINGLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Early psychosocial stimulation (LTP)
The 10 session of Early psychosocial stimulation (LTP)will be delivered to depressed mothers in the intervention group
Learning through Play (LTP) groups will be conducted weekly for the first eight sessions and two fortnightly sessions. Parenting issues will be discussed with the mothers and play activities will be demonstrated with the children using LTP and home made materials.
Other Names:
  • Learning Through Play
  • Psychosocial Intervention for Maternal depression
  • Randomized Control Trial
ACTIVE_COMPARATOR: Waiting group
Waiting group will receive standard follow-up by their own LHWs. This group intervention will be documented at baseline, 3 months (end of the trial) and at 6 months. Similar training of Learning through Play will be provided to the mothers in this group at the end of the study.
Learning through Play (LTP) groups will be conducted weekly for the first eight sessions and two fortnightly sessions. Parenting issues will be discussed with the mothers and play activities will be demonstrated with the children using LTP and home made materials.
Other Names:
  • Learning Through Play
  • Psychosocial Intervention for Maternal depression
  • Randomized Control Trial

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The primary outcome measure will be mother's depression scores on EPDS.
Time Frame: change in scores from baseline to 3-month and 6month
The EPDS is a 10-item symptoms scale for postnatal depression that has been validated in the Pakistani population. Higher scores indicate higher level of depression
change in scores from baseline to 3-month and 6month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Children's height
Time Frame: change in scores from baseline to 3-month and 6-month
Height measured in cm
change in scores from baseline to 3-month and 6-month
Children's weight
Time Frame: Change in scores from baseline to 3-month and 6-month
Weight measured in kgs
Change in scores from baseline to 3-month and 6-month
Children's head circumference
Time Frame: Change in scores from baseline to 3-month and 6-month
Measured in cm
Change in scores from baseline to 3-month and 6-month
Children's arm circumference
Time Frame: Change in scores from baseline to 3-month and 6-month
measured in cm
Change in scores from baseline to 3-month and 6-month
mother's depression score on Hamilton Rating Scale for Depression HAMD
Time Frame: Change in scores from baseline to 3-month and 6-month
HAMD was used to assess severity of depression, Higher score indicates higher level of dpression.
Change in scores from baseline to 3-month and 6-month
Mother's scores on Parenting stress Index
Time Frame: Change in scores from Baseline to 3-month and 6-month
used to assess maternal stress in their role as a parent. Higher scores indicate higher level of stress.
Change in scores from Baseline to 3-month and 6-month
mothers' scores on knowledge, attitude and and practices Questionnaire
Time Frame: Change in scores from baseline to 6-month
used to assess change in maternal knowledge, attitude and practices. Higher scores indicate higher level of knowledge about child development.
Change in scores from baseline to 6-month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Dr. Nusrat Husain, Pakistan Institute of Living and Learning

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

February 1, 2009

Primary Completion (ACTUAL)

July 1, 2010

Study Completion (ACTUAL)

January 1, 2011

Study Registration Dates

First Submitted

February 1, 2009

First Submitted That Met QC Criteria

February 1, 2009

First Posted (ESTIMATE)

February 3, 2009

Study Record Updates

Last Update Posted (ACTUAL)

October 14, 2020

Last Update Submitted That Met QC Criteria

October 9, 2020

Last Verified

August 1, 2019

More Information

Terms related to this study

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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