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The effectiveness and cost-effectiveness of the peer-delivered Thinking Healthy Programme for perinatal depression in

Siham Sikander¹, Anisha Lazarus², Omer Bangash³

¹Human Development Research Foundation, Islamabad, Pakistan. siham.sikander@hdrfoundation.org.

|November 26, 2015

Insights

Peer-delivered psychological interventions show promise for treating perinatal depression in South Asia, addressing a critical need due to limited healthcare professionals. This study evaluates the Thinking Healthy Programme Peer-delivered (THPP) for mothers facing moderate to severe depression.

Area of Science:

Global Mental Health
Perinatal Mental Health
Psychological Interventions

Background:

South Asia faces high rates of perinatal depression (antenatal and postnatal depression).
Existing health systems struggle to deliver psychological treatments due to human resource shortages.
This study protocol evaluates a peer-delivered intervention for perinatal depression.

Purpose of the Study:

To evaluate the effectiveness and cost-effectiveness of the Thinking Healthy Programme Peer-delivered (THPP).
To assess THPP for women with moderate to severe perinatal depression in Pakistan and India.
To address the human resource gap in delivering mental health services in low-resource settings.

Main Methods:

Two randomized controlled trials (cluster in Pakistan, individual in India) involving pregnant women screened for depression (PHQ-9 ≥ 10).
Intervention group received THPP sessions delivered by trained peers; control group received enhanced usual care.
Primary outcomes: depression symptom remission and severity at 6-month postnatal follow-up; intention-to-treat analysis.

Main Results:

Primary outcomes (depression remission and severity) will be assessed at 6-month postnatal follow-up.
Secondary outcomes include depression at 3 months, functional disability, social support, breastfeeding, infant growth, and costs.
The intention-to-treat principle will guide the primary analysis.

Conclusions:

The trials aim to strengthen evidence for an WHO-recommended, peer-delivered psychological treatment for perinatal depression.
This approach has the potential to overcome human resource limitations in global mental health.
Findings may advance understanding of peer-delivered interventions within existing health systems in low-resource contexts.

Read full analysis

Abstract

Background:

Rates of perinatal depression (antenatal and postnatal depression) in South Asia are among the highest in the world. The delivery of effective psychological treatments for perinatal depression through existing health systems is a challenge due to a lack of human resources. This paper reports on a trial protocol that aims to evaluate the effectiveness and cost-effectiveness of the Thinking Healthy Programme delivered by peers (Thinking Healthy Programme Peer-delivered; THPP), for women with moderate to severe perinatal depression in rural and urban settings in Pakistan and India.

Methods/Design:

THPP is evaluated with two randomised controlled trials: a cluster trial in Rawalpindi, Pakistan, and an individually randomised trial in Goa, India. Trial participants are pregnant women who are registered with the lady health workers in the study area in Pakistan and pregnant women attending outpatient antenatal clinics in India. They will be screened using the patient health questionnaire-9 (PHQ-9) for depression symptoms and will be eligible if their PHQ-9 is equal to or greater than 10 (PHQ-9 ≥ 10). The sample size will be 560 and 280 women in Pakistan and India, respectively. Women in the intervention arm (THPP) will be offered ten individual and four group sessions (Pakistan) or 6-14 individual sessions (India) delivered by a peer (defined as a mother from the same community who is trained and supervised in delivering the intervention). Women in the control arm (enhanced usual care) will receive health care as usual, enhanced by providing the gynaecologist or primary-health facilities with adapted WHO mhGAP guidelines for depression treatment, and providing the woman with her diagnosis and information on how to seek help for herself. The primary outcomes are remission and severity of depression symptoms at the 6-month postnatal follow-up. Secondary outcomes include remission and severity of depression symptoms at the 3-month postnatal follow-up, functional disability, perceived social support, breastfeeding rates, infant height and weight, and costs of health care at the 3- and 6-month postnatal follow-ups. The primary analysis will be intention-to-treat.

Discussion:

The trials have the potential to strengthen the evidence on the effectiveness and cost-effectiveness of an evidence-based psychological treatment recommended by the World Health Organisation and delivered by peers for perinatal depression. The trials have the unique opportunity to overcome the shortage of human resources in global mental health and may advance our understanding about the use of peers who work in partnership with the existing health systems in low-resource settings.

Trial Registration:

Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014) India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).

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