Growing interest has been shown in the use of peers as lay health workers in maternal healthcare. This review aimed to examine published evidence on the effectiveness of lay support models for the management of postnatal depression (PND).

MEDLINE, EMBASE, PsycINFO and the Cochrane Library were searched for randomised controlled trials (RCTs) of interventions conducted by lay health workers in postnatal women, published between 1980 and August 2010. The search revealed seven studies, totaling 16,095 participants, which reported outcomes in PND and mothers’ mental health/self-esteem.

The value of lay support models depends on the intervention type and the population targeted. Telephone based peer support, for women identified as high-risk for PND, showed a statistically significant reduction in Edinburgh Postnatal Depression Scale (EPDS) scores at 12 weeks. Universal provision of peer mentoring has been shown to significantly improve self-esteem at one year postpartum, but no studies have shown statistical significance on PND or mental health outcomes (measured by EPDS/SF-36). In poor populations, women’s groups led by peer facilitators have been shown to reduce moderate depression by 57%, compared to controls. However, another study, which evaluated community group support showed a low uptake (19%) resulting in no statistical significance. Similarly there was no significant improvement in PND with self-help manuals, despite one study reporting favorable feedback.

There is some evidence from RCTs that high-risk groups and specific demographics can benefit from targeted peer support. However, no particular model can be strongly recommended, and further research is required.