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The study, published in The Lancet, recruited more than 4,000 women from across the UK and was written by researchers from both NHS Trusts and universities across the UK, including Professor Kam Bhui, in the Department of Psychiatry, University of Oxford.
The study was led by joint first authors Professor Nusrat Husain from the University of Manchester and Mersey Care, and Farah Lunat, Research Operations Manager at Lancashire and South Cumbria NHS Foundation Trust (LSCft).
The study compared a talking treatment for postnatal depression developed specifically for British South Asian women called the ‘Positive Health Programme’, which was delivered in a group setting, to usual treatment provided by a GP. The aim was to find out if the group talking treatment worked and if it was value for money.
It was found that more women in the Positive Health Programme group recovered after four months, compared to the treatment-as-usual group. By 12 months, the women in the Positive Health Programme group continued to stay well, but by that time the women in the usual treatment group also recovered. The results are promising as more women in the Positive Health Programme group recovered both quickly and significantly, which has implications for developing future care.
These findings have helped researchers and health professionals to better understand how to best engage with British South Asian families. As a result of the study, recommendations have been made to policy makers in health care, specifically around the availability of culturally sensitive treatment options for British South Asian women who experience postnatal depression.
Professor Bhui said: "Maternal depression can affect bonding and attachment whether a child thrives in those early years. Depression in South Asian mothers requires tailored interventions taking account of social and cultural influences. ROSHNI showed significant short term benefits, questioning how to promote prolonged recovery. The study demonstrates how to undertake inclusive research and reduce ethnic inequalities in experience and outcomes of mental illness.
There are significant lessons for inclusive research in health and social care, and research infrastructures, and evidence that cultural adaptation of CBT and psychological interventions in general can tackle gender and ethnic disparities, with significant implications for children."
Farah Lunat, Research Operations Manager LSCft and joint-lead author of article, commented: “British South Asian women represent a significant population in the UK, and we know they are at a higher risk of postpartum depression, yet there has not, to our knowledge, been any other large-scale research into how we can better support them. This has to change and ROSHNI-2, signals the start of this change.”
"Perhaps even more significant than the positive mental health outcomes of this research, the ROSHNI-2 trial has proven that inclusive research is possible.
The BAME community that is so often labelled as 'hard to reach' is, in fact, ‘easy to ignore’. There is a need for a shift in attitudes amongst healthcare professionals, academics and service providers. ROSHNI-2 has proved that a culturally inclusive approach to research does work and has huge potential benefits to improving access to healthcare for underrepresented communities.”
British South Asian women are statistically more likely to experience mental health issues, however they present to mental health services at a considerably lower rate than White women. Black and Asian minority groups make up 13% of the UK population with British South Asian women as the largest ethnic minority group in the UK This represents a significant proportion of the population that is currently underserved by mental health services and often not accounted for when recruiting research participants.
The reasons for this are complex and include factors such as family engagement, language barriers, cultural perceptions of mental health and a lack of culturally sensitive services. To help overcome these barriers, the ROSNHI2 study pioneered a culturally adapted model of recruiting, engaging and retaining research its participants.
As part of its culturally adapted model, the study offered a ‘Positive Health Programme’, a talking therapy in a group setting which was offered to all participants and included delivery in five different languages, crèche provision and reimbursement for travel expenses, as well as sessions on topics from a culturally-aware point of view, such as pressures and expectations on women, confidence and self-esteem, religion and spirituality.