Delivering the Thinking Healthy Programme for Perinatal Depression Through Volunteer Peers: A Cluster Randomised Controlled Trial in Pakistan

Sikander, Siham; Ahmad, Irshad; Atif, Najia; Zaidi, Ahmed; Vanobberghen, Fiona; Weiss, Helen; Nisar, Anum; Tabana, Hanani; Ain, Qurat ul; Bibi, Amina; Bilal, Samina; Bibi, Tayyiba; Sharif, Maria; Zulifiqar, Shaffaq; Fuhr, Daniela C.; Price, LeShawndra N.; Patel, Vikram; Rahman, Atıf

doi:10.2139/ssrn.3204906

Cited by 29 publications

(61 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The psychological intervention used was an adaptation of the World Health Organisation’s manual “Thinking Healthy: A manual for psychosocial management of perinatal depression”, based on Atif Rahman’s Thinking Healthy Programme. The Thinking Healthy Programme is an evidence-based intervention for perinatal depression which has been shown to reduce symptoms of depression and increase women’s functioning [ 13 ]. It follows a cognitive behavioural approach and can be adapted to suit various contexts, depending on available resources.…”

Section: Methodsmentioning

confidence: 99%

“…There are various manualised, short-term psychological interventions that have been developed in LMICs, which have a good evidence base in treating common perinatal mental disorders (CPMD). Based on Cognitive Behavioural Therapy, the Thinking Healthy Programme (THP) is one such intervention that has demonstrated successful treatment of CPMD [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

Tomlinson

Chaudhery

Ahmadzai

et al. 2020

Int J Ment Health Syst

View full text Add to dashboard Cite

Background The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery. Methods This exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme. Results Of the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention. Conclusion In poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

Tomlinson

Chaudhery

Ahmadzai

et al. 2020

Int J Ment Health Syst

View full text Add to dashboard Cite

show abstract

“…The intervention was the Thinking Healthy Programme, Peer Delivered (THPP), a low intensity psychotherapy program, delivered by peer counselors (Sikander et al, 2015). Intervention sessions began during pregnancy and lasted through 6 months post-partum, and were successful in reducing the duration of the depression episode (Sikander et al, 2019). Follow-up interviews were conducted at 3, 6, and 12 months post-partum.…”

Section: Study Setting and Samplementioning

confidence: 99%

Father involvement in the first year of life: Associations with maternal mental health and child development outcomes in rural Pakistan

Maselko

Hagaman

Bates

et al. 2019

Social Science & Medicine

Self Cite

View full text Add to dashboard Cite

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily nonresident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health.

show abstract

“…Natural remission seems to be more frequent in mild and moderate cases of depression (1,38,39); c) the current study was conducted in the outpatient setting of an urban hospital with the patients of CMDs seeking treatment for their symptoms and excluded clients which needed in-patient care for more severe symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…The findings of our study indicate that trained, non-specialist psychology graduates can effectively deliver psychological interventions to improve treatment outcomes for CMDs in specialist mental health care facilities in LMICs. Nonspecialists such as psychology graduates, nurses, community health workers and peer volunteers, are an additional human resource that have been trained to deliver evidence based mental health care services in low resource settings (6,8,9,35,38,41,42).…”

Section: Resultsmentioning

confidence: 99%

Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial

Hamdani

Huma

Masood

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. Methods A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N=192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM+ plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS-12) at 20-weeks after baseline. Results The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20-weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, -3.10; 95% CI, −0.26 to −5.76); p =0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, -4.35; 95% CI, -1.45 to -7.24); p =0.004 in PM+ plus TAU versus TAU group. The follow-up rate was 67% at primary end-point. Conclusions Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care.

show abstract

Delivering the Thinking Healthy Programme for Perinatal Depression Through Volunteer Peers: A Cluster Randomised Controlled Trial in Pakistan

Cited by 29 publications

References 0 publications

Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

Father involvement in the first year of life: Associations with maternal mental health and child development outcomes in rural Pakistan

Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial

Contact Info

Product

Resources

About