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 A.; Nisar, Anum; Tabana, Hanani; Ain, Qurat ul; Bibi, Amina; Bilal, Samina; Bibi, Tayyiba; Liaqat, Rakshanda; Sharif, Maria; Zulfiqar, Shaffaq; Fuhr, Daniela C.; Price, LeShawndra N.; Patel, Vikram; Rahman, Atıf

doi:10.1016/s2215-0366(18)30467-x

Cited by 137 publications

(175 citation statements)

References 30 publications

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“…Four (29%) of 14 studies took place in post-conflict regions, one (7%) in a refugee camp, and the remaining seven (50%) in regions unaffected by recent conflict (defined as conflict within the 5 years before data collection). All studies were published after 2010 and used individual randomisation of participants, except three studies [25][26][27] in which randomisation was at the cluster level. No studies included participants younger than 13 years.…”

Section: Resultsmentioning

confidence: 99%

“…27,28,31 or Violence, War, Abduction and Exposure Scale. 22 Most studies asked a single question about intimate partner violence 32,33 or domestic violence 21,26,29,30,34 exposure, which might have included abuse by non-partners. Some studies 26,33,34 asked about intimate partner violence in the past 3 months only.…”

Section: Figure 1: Study Selectionmentioning

confidence: 99%

“…Included interventions were delivered by various staff: a public health professional and researcher, 28 psychology Masters-educated therapists, 29 community mental health workers, 21,30 general health workers, 31,33 other community workers, 27 and lay individuals. 22,25,26,32,34 Five studies [25][26][27]32,34 compared the control intervention (enhanced usual care [EUC]) with the intervention plus EUC, but the content of EUC, and other studies' control interventions, varied from face-to-face or telephone-delivered basic counselling 31,33 to diagnosis and the opportunity for WHO mental health gap action programme intervention guided treatment, 26,32,34 a home visit, 27 film screenings, 28 and waiting lists. 21,22,29,30 Numbers of sessions ranged from three 28 to 14, 33 delivered at clinics, 21,30 in community settings, 25,27,28 at home, 22,31,34 or a mixture of locations.…”

Section: Figure 1: Study Selectionmentioning

confidence: 99%

“…21,22,29,30 Numbers of sessions ranged from three 28 to 14, 33 delivered at clinics, 21,30 in community settings, 25,27,28 at home, 22,31,34 or a mixture of locations. 26,32,33 Most interventions were delivered individually, with two in groups 27,28 and one mixed. 26 All studies, except two, 28,33 reported significant improvements in at least one CMD in the intervention group compared with the control group.…”

Section: Figure 1: Study Selectionmentioning

confidence: 99%

“…26,32,33 Most interventions were delivered individually, with two in groups 27,28 and one mixed. 26 All studies, except two, 28,33 reported significant improvements in at least one CMD in the intervention group compared with the control group. Mean baseline CMD scores differed between women who did and did not report intimate partner violence in none of the five interventions reporting anxiety symptoms, in two (25%) of eight interventions reporting PTSD symptoms, in five (42%) of 12 interventions reporting depression symptoms, and in one (25%) of four interventions reporting psychological distress symptoms (appendix pp [8][9].…”

Section: Figure 1: Study Selectionmentioning

confidence: 99%

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Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis

Keynejad

Hanlon

Howard

2020

The Lancet Psychiatry

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Background Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs).Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. FindingsOf 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I²=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI -0·06 to 0·33, I²=42·6%), depression (12 interventions, n=2940; 0·10, -0·04 to 0·25, I²=49·3%), and psychological distress (four interventions, n=1591; 0·07, -0·05 to 0·18, I²=0·0%, p=0·681).Interpretation Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs.

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Section: Resultsmentioning

confidence: 99%

Section: Figure 1: Study Selectionmentioning

confidence: 99%

Section: Figure 1: Study Selectionmentioning

confidence: 99%

Section: Figure 1: Study Selectionmentioning

confidence: 99%

Section: Figure 1: Study Selectionmentioning

confidence: 99%

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Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis

Keynejad

Hanlon

Howard

2020

The Lancet Psychiatry

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Policy Makers’ Tough Choices for Psychological Interventions in Global Mental Health

2020

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such articles and plan to publish them on an ongoing basis. We welcome inquiries and submissions regarding any of these article types from interested authors. Our goal is to publish a journal that disseminates the best new original research in psychiatry while also providing useful clinical updates, both for a scientific and a general psychiatry audience.The past year brought more news about the worsening public health impact of psychiatric and substance use disorders. Life expectancy in the US is shortening for the first time in decades 8 partly due to deaths of despair, ie, excess deaths attributable to drug and alcohol use or suicide. I regularly meet patients and families grappling with devastating psychiatric disorders where available treatments are not enough to improve their quality of life, and I know many of you do as well. Psychiatry is at the frontlines of the battle to improve the lives of our patients and their families, and we must redouble our efforts to deliver on this hope. JAMA Psychiatry will continue to do its part in the new decade.

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Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries

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Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan

Cited by 137 publications

References 30 publications

Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis

Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis

Policy Makers’ Tough Choices for Psychological Interventions in Global Mental Health

Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries

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