Maternal depression can affect up to 25 per cent of mothers in South Asia, and most women do not receive the psychosocial interventions that are known to promote recovery, such as Thinking Healthy Programme, an initiative endorsed by the World Health Organisation (WHO). Two studies, one each from India and Pakistan, to be published on Friday in the Lancet Psychiatry, demonstrate the effectiveness of lay women (those who don’t have formal mental health training but have shown an interest or desire to help other women) delivering the Thinking Healthy Programme for other mothers in their communities, who suffer from perinatal depression.
A total of 92 women (called Sakhis in Goa and Razaakars in Rawalpindi, Pakistan) were trained to deliver the Thinking Healthy Programme, a psychological intervention developed by Atif Rahman from the Institute of Psychology, Health and Society, University of Liverpool and his team in Pakistan, to mothers in their communities.
Depression is the leading cause of disability worldwide, and it is a major contributor to the overall global burden of disease in women. Perinatal depression, defined as depression that occurs during pregnancy or within the first year post-partum, affects 5-25 per cent of women. Over 400 depressed pregnant women, identified either through antenatal clinics (in Goa) or the community (in Rawalpindi), received the intervention. Funded by the National Institute of Mental Health at the National Institutes of Health, USA, the study was conducted by the Human Development Research Foundation in Pakistan and Sangath in India.
The studies show that the intervention led to improved recovery over six months following childbirth. Dr Vikram Patel, professor of the Department of Global Health and Population at Harvard TH Chan School of Public Health and the principal investigator in India, said findings show that lay women in the community can be engaged as the first line of providers to deliver evidence-based psychological intervention for one of the most common mental health conditions affecting women, in two diverse settings of south Asia.
“The studies also demonstrate how researchers in India and Pakistan can collaborate to produce world-class science, which is also of great policy relevance,” Patel told The Indian Express. “At this most critical time-point, maternal depression can seriously hinder the child’s development, in addition to causing great suffering to the mother. Our studies show that peer-delivered intervention leads to quicker and more sustained recovery and is cost-effective”, said Atif Rahman, the principal investigator in Pakistan.
Teja Kankonkar, a ‘Sakhi’ who is part of the Thinking Healthy Programme, said, “I am a mother of three children and am aware of the challenges during and after pregnancy. I was given additional training on dealing with difficult situations and recognise worsening symptoms. The impact has been such that it helped promote recovery from depression during the postnatal period”.
The programme appears to have a greater benefit for women, as it significantly improved the women’s perceived social support during the six months after child birth, and reduced disability in the three months after childbirth, researchers added. This finding is of public health relevance because it could enable use of a new cadre of health-care workers who are able to tackle the treatment gap of maternal depression in India, added Patel.