Siham Sikander|Irshad Ahmad|Najia Atif|Ahmed Zaidi|Fiona Vanobberghen|Helen A. Weiss|Anum Nisar|Hanani Tabana|Qurat ul Ain|Amina Bibi|Samina Bilal|Tayyiba Bibi|Rakshanda Liaqat|Maria Sharif|Shaffaq Zulfiqar|Daniela C. Fuhr|LeShawndra N. Price|Vikram Patel|At?f Rahman
Human Development Research Foundation|Health Services Academy|Human Development Research Foundation|Human Development Research Foundation|Human Development Research Foundation|London School of Hygiene & Tropical Medicine|Medical Research Council|London School of Hygiene & Tropical Medicine|Medical Research Council|Human Development Research Foundation|University of the Western Cape|Human Development Research Foundation|Human Development Research Foundation|Human Development Research Foundation|Human Development Research Foundation|Human Development Research Foundation|Human Development Research Foundation|Human Development Research Foundation|Faculty of Public Health|London School of Hygiene & Tropical Medicine|National Institute of Mental Health|National Institutes of Health|National Heart Lung and Blood Institute|Harvard University|Harvard Global Health Institute|University of Liverpool
thinking healthy programme thp endorsed evidencebased intervention perinatal depression adapted thp delivery volunteer peers laywomen community address human resource needs bridging treatment gap aimed assess effectiveness costeffectiveness rawalpindi pakistanin cluster randomised controlled trial randomly assigned 40 village clusters 11 provide either thp peerdelivered thpp enhanced usual care euc intervention group euc control group participants within clusters villages randomly selected eligible villages independent researcher participants pregnant women aged 18 years older scored least 10 patient health questionnaire9 phq9 recruited households within communities rawalpindi pakistan research teams responsible recruiting trial participants masked treatment allocations participants attended followup visits 3 6 months childbirth primary outcomes severity depressive symptoms assessed phq9 score prevalence remission defined phq9 score less 5 participants available data 6 months childbirth assessed researchers masked treatment allocations analysed outcomes intention treat adjusting covariates defined priori showed imbalance baseline trial registered clinicaltrialsgov number nct02111915between april 15 july 30 2014 randomly selected 40 46 eligible village clusters assessment per sample size calculations oct 15 2014 feb 25 2016 identified screened 971 women 20 village clusters randomly assigned thpp euc group 939 women 20 village clusters randomly assigned euc group intervention group 79 women ineligible inclusion 11 women refused screening 597 women screened negative phq9 one woman consent participate control group 75 women ineligible inclusion 14 women refused screening 562 women screened negative phq9 one woman consent participate enrolled 283 29 women intervention group 287 31 women control group 6 months childbirth 227 80 women thpp euc group 226 79 women euc group assessed primary outcome severity depression assessed phq9 scores standardised mean difference 013 95 ci 031 006 p007 prevalence remission 49 intervention group vs 45 control group prevalence ratio 112 95 ci 095 129 p014 significantly differ groups 6 months childbirth evidence significant differences serious adverse events groupsthpp effect symptom severity remission perinatal depression 6 months childbirth found beneficial metrics severity disability costeffective thpp could step towards use unused human resource address treatment gap perinatal depressionnational institute mental health usa