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. 2020 Mar 15:265:660-668.
doi: 10.1016/j.jad.2019.11.110. Epub 2019 Nov 23.

Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan

Fiona Vanobberghen  1 , Helen A Weiss  2 , Daniela C Fuhr  3 , Siham Sikander  4 , Ejma Afonso  5 , Ikhlaq Ahmad  6 , Najia Atif  6 , Amina Bibi  6 , Tayyaba Bibi  6 , Samina Bilal  6 , Aveena De Sa  5 , Ethel D'Souza  5 , Akankasha Joshi  5 , Priya Korgaonkar  5 , Revathi Krishna  5 , Anisha Lazarus  5 , Rakshanda Liaqat  6 , Maria Sharif  6 , Benedict Weobong  7 , Ahmed Zaidi  6 , Shaffaq Zuliqar  6 , Vikram Patel  8 , Atif Rahman  9
Affiliations

Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan

Fiona Vanobberghen et al. J Affect Disord. .

Abstract

Background: The Thinking Healthy Programme (THP) is recommended to treat perinatal depression in resource-limited settings, but scale-up is hampered by a paucity of community health workers. THP was adapted for peer-delivery (THPP) and evaluated in two randomized controlled trials in India and Pakistan. Our aim was to estimate the effectiveness of THPP on maternal outcomes across these two settings, and evaluate effect-modification by country and other pre-defined covariates.

Methods: Participants were pregnant women aged≥18 years with depression (Patient Health Questionnaire (PHQ-9) score≥10), randomized to THPP plus enhanced usual care (EUC) or EUC-only. Primary outcomes were symptom severity and remission (PHQ-9 score<5) 6 months post-childbirth. Secondary outcomes included further measures of depression, disability and social support at 3 and 6 months post-childbirth.

Results: Among 850 women (280 India; 570 Pakistan), 704 (83%) attended 6-month follow-up. Participants in the intervention arm had lower symptom severity (PHQ-9 score adjusted mean difference -0.78 (95% confidence interval -1.47,-0.09)) and higher odds of remission (adjusted odds ratio 1.35 (1.02,1.78)) versus EUC-only. There was a greater intervention effect on remission among women with short chronicity of depression, and those primiparous. There were beneficial intervention effects across multiple secondary outcomes.

Limitations: The trials were not powered to assess effect-modifications. 10-20% of participants were missing outcome data.

Conclusions: This pooled analysis demonstrates the effectiveness, acceptability and feasibility of THPP, which can be scaled-up within a stepped-care approach by engaging with the existing health care systems and the communities to address the treatment gap for perinatal depression in resource-limited settings.

Trial registration: ClinicalTrials.gov NCT02104232 NCT02111915.

Keywords: Community health workers; Depression; India; Pakistan; Patient health questionnaire; Pregnancy.

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Conflict of interest statement

Declaration of Competing Interest Declarations of interest: none.

Figures

Figure 1.
Figure 1.. A) Remission (PHQ-9 score <5) and B) symptom severity (PHQ-9 score) at 6 months by potential effect modifiers.
PHQ=Patient Health Questionnaire. Results are from linear or logistic generalized estimating equation models, adjusted for country, recruitment site, residence, union council, baseline symptom severity, treatment expectations, education, chronicity of depression, and time between screening and birth. The sizes of the squares indicating the point estimates are proportional to the number of participants in each category. These results are described further in Table 4 and Appendix Tables A3 and A4.
Figure 1.
Figure 1.. A) Remission (PHQ-9 score <5) and B) symptom severity (PHQ-9 score) at 6 months by potential effect modifiers.
PHQ=Patient Health Questionnaire. Results are from linear or logistic generalized estimating equation models, adjusted for country, recruitment site, residence, union council, baseline symptom severity, treatment expectations, education, chronicity of depression, and time between screening and birth. The sizes of the squares indicating the point estimates are proportional to the number of participants in each category. These results are described further in Table 4 and Appendix Tables A3 and A4.
See this image and copyright information in PMC

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