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We read the article by Patterson et al with interest.1 Firstly, the percentage of questionnaires returned from the survey should have been 61.8% not 70%, as reported.
Secondly, mental health problems are prevalent in people of lower socioeconomic class. Unfortunately, working class parents were seriously under-represented in the study. The results from educated and predominantly caucasian people from Oxford are not applicable to areas like ours. In the Camden and Islington boroughs of London, we work with parents of mostly lower socioeconomic class and of varied ethnicity—from Albania to Zaire—to whom these results are not relevant. We need more studies conducted in these people to know the best evidence.
Thirdly, the intervention effect is seen at 6 months (short term) follow up. We wonder whether the maturational effect seen in the control group will actually decrease the effect of parenting in the intervention group in the long term?1 Moreover the intervention effect is said to be statistically significant. But is it clinically significant as well? And there is no cost-benefit analysis given.2 Does this justify the considerable use of resources, especially in today’s cash strapped, staff depleted (fewer health visitors) NHS? Furthermore, parents in the intervention group might have believed that the parenting programme is efficacious, and consequently feel and perform better than those who were in the control group, as they were aware of …