Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan

Maselko, Joanna; Sikander, Siham; Turner, Elizabeth L.; Bates, Lisa M.; Ahmad, Irshad; Atif, Najia; Baranov, Victoria; Bhalotra, Sonia R.; Bibi, Amina; Bibi, Tayyaba; Bilal, Samina; Biroli, Pietro; Chung, Esther O.; Gallis, John A.; Hagaman, Ashley; Jamil, Anam; LeMasters, Katherine; O’Donnell, Karen; Scherer, Elissa; Sharif, Maria; Waqas, Ahmed; Zaidi, Ahmed; Zulfiqar, Shaffaq; Rahman, Atıf

doi:10.1016/s2215-0366(20)30258-3

Cited by 46 publications

(70 citation statements)

References 49 publications

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“…However future studies should include longer‐term FU as evidence suggests that depressive symptoms may worsen as the child grows (Evans et al, 2012). A recent cluster RCT of a peer‐delivered psychosocial intervention (The Thinking Healthy Program, Peer‐delivered Plus, THPP+) in rural Pakistan showed no significant differences between the intervention group and enhanced usual care with regards to maternal depression symptoms and child socio‐emotional skills (strengths and difficulties questionnaire [SDQ‐TD]) at 36‐month postnatal FU (Maselko et al, 2020). However, LTP+ distinguishes itself from THPP+ by integrating a parental training program with CBT principles, and hence may have different long‐term benefits when compared to THPP+ alone.…”

Section: Discussionmentioning

confidence: 99%

“…Program, Peer-delivered Plus, THPP+) in rural Pakistan showed no significant differences between the intervention group and enhanced usual care with regards to maternal depression symptoms and child socio-emotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-month postnatal FU (Maselko et al, 2020). However, LTP+ distinguishes itself from THPP+ by integrating a parental training program with CBT principles, and hence may have different long-term benefits when compared to THPP+ alone.…”

Section: Discussionmentioning

confidence: 99%

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An integrated parenting intervention for maternal depression and child development in a low‐resource setting: Cluster randomized controlled trial

Husain

Kiran

Fatima

et al. 2021

Depression and Anxiety

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Background Rates of depression among Pakistani mothers are high, leading to poor developmental outcomes in their children. This study tested the effectiveness of a manualized integrated parenting program; Learning through Play Plus (LTP+) for maternal depression in Karachi, Pakistan. Methods A cluster randomized control trial conducted from January 2014 to December 2015 across 120 villages in Karachi. A total of 774 depressed mothers aged 18–44 years with children aged 0–30 months old, were included. Villages were randomized to receive LTP+ added to treatment as usual (TAU) or TAU alone. Primary outcomes were severity of maternal depression at 3 and 6 months measured by the Edinburgh Postnatal Depression Scale and child socio‐emotional development at 6 months measured by the Ages and Stages Questionnaire (ASQ). Secondary outcomes included maternal anxiety, quality of life, social support, parenting competence, and knowledge about child development. Results Mothers in the LTP+ group reported significantly lower depression scores compared to those in the TAU group (6.6 vs. 13.8, effect size [ES]: −7.2; 95% confidence interval [CI]: −8.2, −6.1) at 3 and 6 months (7.2 vs. 12.00; ES: −4.6; 95% CI: −5.9, −3.4). Child socio‐emotional development at 6 months was significantly better in the LTP+ group on all domains of the ASQ. There were also statistically significant improvements on all secondary outcomes at 3‐ and 6‐month follow‐up. Conclusion In low‐resource settings like Pakistan, low‐cost integrated parenting interventions delivered by lay health workers can provide effective treatment for depressed mothers, leading to improvements in child development.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An integrated parenting intervention for maternal depression and child development in a low‐resource setting: Cluster randomized controlled trial

Husain

Kiran

Fatima

et al. 2021

Depression and Anxiety

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“…Past research has shown that those receiving the intervention showed reduced depressive symptoms at 6 months; however, the effects of the intervention weakened over time. 47 48 In addition, an equal number of non-depressed pregnant women were recruited and followed in parallel as part of the Bachpan cohort to understand the degree to which the intervention could mitigate the risk of intergeneration transmission of poor mental health from mothers to their children. 47 Women were assessed at baseline (during their third trimester of pregnancy) and at an additional five timepoints: 3, 6, 12, 24 and 36 months post partum.…”

Section: Methodsmentioning

confidence: 99%

“… 47 48 In addition, an equal number of non-depressed pregnant women were recruited and followed in parallel as part of the Bachpan cohort to understand the degree to which the intervention could mitigate the risk of intergeneration transmission of poor mental health from mothers to their children. 47 Women were assessed at baseline (during their third trimester of pregnancy) and at an additional five timepoints: 3, 6, 12, 24 and 36 months post partum. At the 36-month assessment, participants completed questionnaires assessing ACEs, anxiety and perceived stress.…”

Section: Methodsmentioning

confidence: 99%

Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study

et al. 2022

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ObjectivesAdverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan.DesignThis study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum.SettingAll participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers.ParticipantsData were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol.Primary and secondary outcomes measuresACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables.ResultsAll models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production.ConclusionsAll four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.

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“…This area was selected for a number of reasons as it is geographically, culturally, and socio-economically similar to many other sub-districts of the province and country. It is one of the first districts of Pakistan where the WHO mhGAP has been rolled-out as a pilot and a maternal depression birth cohort and a randomized trial trained peers delivering a perinatal depression psychosocial intervention were ongoing [23,24]. Leveraging all of these on-going activities and studies, one third of UCs (3 out of 11) of Kallar Syedan were purposively selected for the adaptation and accuracy testing of CIDT-MD.…”

Section: Settingmentioning

confidence: 99%

Accuracy of Community Informant Led Detection of Maternal Depression in Rural Pakistan

Mohsin

Ahmed

Atif

et al. 2021

IJERPH

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Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1–3 children while only 17.4% had >3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2–99.1) and 82.4% (95% CI: 77.8–86.4) respectively. It’s positive predictive value (PPV), 77.3% (95% CI: 72.9–81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7–99.2). While factor analysis revealed high inter-item correlation for most items (0.62–0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett’s test of sphericity (p < 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87–0.89) and statistically significant known group analysis (p < 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.

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Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan

Cited by 46 publications

References 49 publications

An integrated parenting intervention for maternal depression and child development in a low‐resource setting: Cluster randomized controlled trial

An integrated parenting intervention for maternal depression and child development in a low‐resource setting: Cluster randomized controlled trial

Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study

Accuracy of Community Informant Led Detection of Maternal Depression in Rural Pakistan

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