Effect of the thinking healthy programme-based internet intervention model for maternal perinatal depression: A pilot...

Thinking Healthy Programme (THP) is an evidence-based psychosocial intervention that can be delivered by non-psychologists and does not require the implementer to have a mental health background or field experience. The THP has been tested in maternal health in many countries. However, the application of the THP model in Chinese maternal and child health has not been reported.

This study aimed to explore the feasibility of the Thinking Healthy Programme (THP) model for improving perinatal depressive symptoms and infant growth when implemented by non-psychologists (e.g., nurses) for Chinese pregnant women.

122 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) ≥ 10 were selected from a tertiary hospital in Fujian Province between January 2022 to May 2022. Participants were randomly assigned to the intervention group (n = 61) and the control group (n = 61). The intervention group received the THP-based online delivery intervention and enhanced usual care (EUC), while the control group only received EUC. The outcomes were maternal depressive symptoms, infant growth, and other maternal and infant outcomes. Outcomes were assessed at baseline (during pregnancy), 3 months postpartum, and 6 months postpartum.

The Generalized Linear Mixed Model (GLMM) showed that there were significant time effects for EPDS scores and PHQ-9 scores between the two groups over time (p < 0.001, p = 0.040). The depression subscale of EPDS and PHQ-9 scores decreased significantly only within the intervention group between 6 months postpartum and baseline (p = 0.003, p = 0.023), the comparison group did not. Compared with the control group, the intervention group had a statistically significantly longer breastfeeding time (5.52 ± 1.25 vs. 4.50 ± 1.69, p = 0.012) at 6 months postpartum, and a lower absolute value of BMI-for-age z-score at post intervention and follow up post intervention (3 and 6 months post-delivery) (-0.87 ± 1.41 vs. -1.41 ± 2.53, p = 0.229; -0.14 ± 1.19 vs. -0.29 ± 1.11, p = 0.539) although no statistically significant difference.

This study had several limitations. First, it was a single-center study and the sample size was small, which may limit the results. This finding needs to be confirmed by further large multicenter studies. Second, the outcomes were based on maternal self-report alone, which was subjected to social desirability and recall bias. Third, the study only monitored the effects up to the 6-month endpoint. Future studies should incorporate a longer-term evaluation of its effects on infant behavioral and temperament outcomes.

The THP-based online delivery intervention model helped to improve maternal perinatal depressive symptoms, with important benefits for improving maternal and infant health. This suggested the feasibility for non-psychologists to implement the THP model.