Are group nature-based interventions feasible for treating mothers experiencing postnatal mental health difficulties and their infants? A mixed-methods single-arm pilot feasibility study

Problem

Postnatal mental health difficulties, including depression and anxiety, are common and under-treated, especially amongst under-served groups of mothers. There is growing evidence for the potential for ‘Green Social Prescribing’ to improve mental health and reduce health inequalities. This involves connecting people to community nature-based interventions. However, little research has focused on postnatal mothers.

Approach

This study explored the acceptability of a novel co-designed five-week group intervention for mothers experiencing postnatal mental health difficulties and their infants (called ‘The Mother Nature Project’) and the feasibility of implementation in practice. We used a four-group pre-test/post-test design. Each stage of the research was informed by a Patient and Public Involvement (PPI) group comprising ten mothers from diverse backgrounds, including mothers from the refugee community. Eligible mothers (self-reported postnatal mental health difficulties, with an infant <2) were recruited from local charities and children’s centres. The intervention was facilitated by an accredited nature-based practitioner and a perinatal mental health peer support worker in an outdoor community location. Each session comprised three simple ‘forest bathing’ invitations, to engage participants in the natural environment.Assessment of symptoms occurred at baseline, and then after the five-week intervention, using the Edinburgh Postnatal Depression Scale (EPDS), Generalised Anxiety Disorder Assessment (GAD-7), the Warwick-Edinburgh Wellbeing Scale (WEMWBS), and Nature Relatedness score (NR-6). Analysis of feasibility outcomes was based on descriptive statistics and 19 qualitative participant interviews.

Findings

Twenty-eight mother-infant dyads from diverse cultural and socio-economic backgrounds (including refugee women) consented to participate across four intervention groups. Twenty-seven dyads started the programme, 26 were retained, of whom 24 attended at least three sessions. Albeit a small, uncontrolled study, statistical analysis found a promising signal of effect for three of the four outcome measures: the EPDS (mean difference = -4.3 [SD = 4.4], p value 0.009), GAD-7 (mean difference = -4.2 [SD = 3.7], p value 0.004), WEMWBS (mean difference = 8.8 [SD = 6.6], p value 0.001), NR-6 (mean difference = 0.4 [SD = 0.4], p value 0.06).Thematic analysis of 19 qualitative interviews indicated improvements in women’s mood, wellbeing, sleep, confidence, social connectedness, and their relationship with their infant. Women described the value in using metaphors of nature to process difficult experiences in their transition to motherhood. They reported a closer relationship with nature and a greater commitment to pro-environmental behaviours as a result.

Consequences

This study offers preliminary evidence that the postnatal nature-based intervention was feasible to deliver and highly acceptable to mothers. Nature-based interventions may be an important treatment option for mothers experiencing postnatal mental health difficulties, and may have greater cross-cultural validity than current treatment options. However, further research is needed to understand their effectiveness, cost-effectiveness, and how they can be implemented at scale.