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

To determine whether a community- delivered intervention targeting infant sleep problems improves infant sleep and maternal well- being and to report the costs of this approach to the healthcare system. Design: Cluster randomised trial. Setting: 49 Maternal and Child Health ( MCH) centres ( clusters) in Melbourne, Australia. Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October November 2003. Intervention: Behavioural strategies delivered over 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% vs 68%; adjusted OR 0.58 ( 95% CI: 0.36 to 0.94)) and 12 months ( 39% vs 55%; adjusted OR 0.50 ( 0.31 to 0.80)). EPDS scores indicated less depression at 10 months ( adjusted mean difference -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 difference 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 pound 96.93 and pound 116.79 per intervention and control family, respectively. Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system.