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Appendix A: Baseline characteristics of women who do versus do not have 6-month post-childbirth outcome data for the primary endpoint analysis. Have 6-month outcome data for the primary endpoint analysis No (n=117) [1] Yes (n=453) p-value [2] Age, years (mean (SD)) 27 (5.1) 27 (4.7) 0.54 Marital status (n (%)) Married 117 (100%) 453 (100%) -Occupation (n (%)) Does not work Manual worker Non-manual worker 109 (93%) 6 (5%) 2 (2%) 424 (94%) 25 (6%) 4 (1%) 0.77 Education status (n (%)

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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.

Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan.Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using “Patient health questionnaire” (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on “Women's Health and Domestic Violence against Women.”Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p &lt; 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p &lt; 0.01, OR 6.9, CI 1.77–26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p &lt; 0.001, OR 3.2, CI 1.68–5.98) than in women with 1–2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p &lt; 0.01, OR 0.9, CI 0.85–0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p &lt; 0.05 CI 1.12–2.51). Odds of having depression was also high in women who had less mean score of MSSI (p &lt; 0.05, OR 1.1, CI 1.01–1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p &lt; 0.05, OR 0.5, CI 0.27–0.92).Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables.