1. ‘Improving health and wellbeing through Research’ Preston Football Club 17 th October 2014 Improving health and wellbeing through research – October 2014

2. Dr Nusrat Husain Reader (University of Manchester) / Honorary Consultant Psychiatrist “ROSHNI-D: An exploratory randomised control trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin” Theme: Developing Clinical Research Improving health and wellbeing through research – October 2014

3. Increasing access to culturally sensitive Psychological Interventions Nusrat Husain Reader in Psychiatry Lead Global Mental Health Institute of Brain, Behaviour and Mental Health University of Manchester Research Director Global Health Manchester Academic Health Sciences Centre (MAHSC) Honorary Consultant Psychiatrist Lead Culture & International Mental Health Research Group Lancashire Care NHS Foundation Trust Honorary Director R&D Pakistan Institute of Learning & Living Honorary Research Consultant Centre in Africa for Learning & Living Visiting Research Faculty Hincks DellCrest, University of Toronto

4. ROSHNI-D - Exploratory RCT of a grOup psychological intervention for PoStnatal Depression in BritisH Mothers of South AsiaN OrigIn Culturally appropriate group psychosocial intervention Based on the principles of Cognitive Behaviour Therapy Developed by PHD student now Dr. Sobia Khan and has been pre-tested on a group of 12 women

5. 1 in 6 of England's population belonging to an ethnic minority a increase from 6.6 million in 2001 to 9.1 million in 2009 (ONS, 2011) Source: 2011 Census, Table KS201EW, ONS Source: 2001 Census [Key Statistics for England and Wales

6. Challenges: Mental Health Disparities Ethnic and racial minorities: –Less access to, and availability of, mental health services –Less likely to receive needed mental health services –Those in treatment often receive a poorer quality of mental health care –Underrepresented in mental health research –Experience a greater burden of disability

8. Perinatal depression among British Pakistani women –Social isolation –Language difficulties, don’t speak English fluently –Unemployment –Lack of satisfactory confiding relationship –Low self esteem –Rarely leave home, and then only accompanied by husband or other family member

9. The depression cycle of Pakistani Women Marital problems Low self esteem Social isolation Lack of social support Poor physical health Loss of hope and future aspirations

10. “ Cultural adaptation refers to program modifications that are culturally sensitive & tailored to a cultural group’s traditional world views.” (Kumpfer, 2002).

11. ROSHNI-D: POSITIVE HEALTH PROGRAMME (PHP) (POSTNATAL DEPRESSION) Culturally appropriate group psychosocial intervention Based on the principles of Cognitive Behaviour Therapy Developed by PHD student now Dr. Sobia Khan and has been pre-tested on a group of 12 women

12. RCT of a Complex Intervention for Postnatal Depression in British Mothers of South Asian Origin A letter from the GP at 6 weeks postnatal informed the women about the trial, invite their participation and request their written informed consent Women who score =≥12 on EPDS and a selection of low scorers were invited for the second stage interviews All consenting women were administered the Clinical Interview Schedule Revised CIS-R to confirm the ICD 10 diagnosis of depression Women who fulfilled the inclusion criteria were then asked to provide a second written consent for randomization

13. Positive Health Programme (PHP) Session 1: Introduction to the PHP Session 2: Pressures and expectations of women

14. EXAMPLES AND STORIES ARE USED IN THE MANUAL TO HELP WOMEN UNDERSTAND THE VICIOUS CIRCLE OF DEPRESSION (ABC MODEL) I can’t do anything right I don’t play with the children anymore I can’t get to sleep

15. Understanding the role of our thoughts and feelings on our behaviour in maintaining low self esteem To encourage members to implement change in their lives in terms of achieving good self- esteem Session 3 -Understanding and managing self-esteem

16. Session 4 - Keeping up with the Chaudhrys (Joneses) To unveil feelings of envy and jealousy and learn from others Life is NOT a race

17. Session 5 – Exercise and looking good Identify the pressures on women wanting to look good To identify negative feelings associated with our body image To discuss the consequences of dieting or overeating The looking good and feeling good connection Exercise as a way of managing good weight

18. Session 6- Religion and Spirituality Identifying negative beliefs about “Punishment from God” To challenge our negative thoughts regarding religion using the ABC model Using spirituality as means of increasing inner calm

19. Positive Health Programme (PHP) Session 7: Relaxation Session 8: Assertiveness and confidence Session 9: Breaking social isolation Session 10: Discussion group Session 11: Discussion group

20. Final Session (12 th ) Goodbye session Planned as completion of training and certificate distribution ceremony All dressed up Exchange contacts Remember follow up

21. RESULTS: Demographics InterventionControlTotal Age mean (S.D)30.43(5.96)30.05(5.37)- Ethnicity N (%) Indian5 (11.90%7 (17.07%)12 (14.46%) Pakistani36 (85.71%)32 (78.05%)68 (81.93%) Other Asian1 (02.38%) -1 (01.20%) Unknown -2 (4.88%)2 (02.41%)

22. EPDS ScoreInterventionControlP-value Baseline 16.69 15.17 NS Follow-up 1 8.03 8.53 Follow-up 2 9.38 9.07

23. Attendance at Roshni-D Groups (mean 6.6 – 10.4) Weekly Sessions No. of Participants

24. Analysis of Completers Completers were defined as those participants who had attended 4 or more sessions. Fifteen of the 42 patients in the intervention group did not attend any of the therapy sessions, while the remaining 27 patients attended at least 4 sessions.

25. Spearman’s correlation coefficient between the number of sessions attended and reduction in Hamilton score from baseline to follow up 1 was 0.35, p=0.048, with greater reductions in Hamilton score being associated with more sessions attended. Correlations between changes from baseline to follow-ups in the other variables ranged from - 0.20 for EPDS at 2nd follow up to 0.40 for DAS at 2nd follow up.

26. Results All the participants reported improved well-being since attending the PHP. Women reported improvements in their lifestyle by being more proactive, enhanced self-esteem, being able to manage stress more effectively. Embracing and adopting a positive view of life. “I am very open now, my behaviour has changed a lot, before I was very reluctant to speak and was yes there is difference, I am more open with people I try to be more communicative and friendly when I go out. It’s an overall change in attitude”

27. The findings suggest that a culturally adapted intervention (PHP) is acceptable to British South Asian women with PND. Interventions targeting PND in BSA women should pay particular attention to ways of improving social support, independent coping strategies, role of facilitator, language aspects, childcare and transport provision and using the group discussion techniques (Stories) Conclusion

28. DIGITAL DM Dissemination and Impact

29. Community engagement day

30. Acknowledgements All The Participants. F Creed, Karina Lovell, R. Gater, N Chaudhry, G. Dunn, J. Jackson, W. Waheed, Sarah Khan, Saadia Aseem, Ayesha Waheed, Najia Atif, N Chaudhry, M Husain, Chaudhry, F Naeem, Farah Lunat, Nadeem Gire, Aleen Syed, Jyothi Neelam, Yumna Masood, Atif Rahman, Barbara Tomenson, Asad Bukhari (Dr Rathod, Dr Naeem and “Cry for Change” for the slides) Funded by UK Medical Research Council. NIH-R Research for Patient Benefit Programme Lancashire Care NHS Foundation Trust University of Manchester.