Improving infant sleep and maternal mental health: a cluster randomised trial

Harriet Hiscock ^1*, Jordana Bayer ¹, Lisa Gold ², Anne Hampton ³, Obioha Ukoumunne ⁴ and Melissa Wake ¹

¹ Centre for Community Child Health, Royal Children's Hospital, Dept Paediatrics Uni of Melb, MCRI, Australia
² School of Public Health, La Trobe University, Australia
³ Centre for Community Child Health, Royal Children's Hospital, Murdoch Childrens Research Institute, Australia
⁴ Clinical Epidemiology & Biostatistics Unit, Royal Children’s Hospital, MCRI;, Dept Paediatrics, Australia

^* To whom correspondence should be addressed. E-mail: harriet.hiscock{at}rch.org.au.

Accepted 22 November 2006

Abstract

Objectives: To 1) determine whether a community- delivered intervention targeting infant sleep problems improves infant sleep and maternal wellbeing and 2) report the costs of this approach to the healthcare system.

Design: Cluster randomised trial.

Setting: 49 Maternal & Child Health (MCH) centres (clusters) in Melbourne, Australia.

Participants: 328 mothers reporting an infant sleep problem at 7-months, recruited from "well-child" appointments (October-November 2003).

Intervention: Behavioural strategies delivered over 1-3 individual structured MCH consultations, versus usual care.

Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10- and 12-months old. Costs included MCH sleep consultations, other healthcare services and intervention costs.

Results:Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% versus 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% versus 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean diff. -1.4 (-2.3 to -0.4) and 12 months (-1.7 (-2.6 to -0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean diff 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively.

Conclusions:Implementing this sleep intervention has the potential to lead to health gains for infants and mothers and resource savings for the healthcare system.

Keywords: cluster randomised trial, maternal depression, maternal wellbeing, sleep

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