Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan
Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan
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DOI：
10.1016/j.jad.2019.11.110
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发表时间：
2020-03-15
影响因子：
6.6
通讯作者：
Rahman, Atif
中科院分区：
文献类型：
--
作者：
Vanobberghen, Fiona;Weiss, Helen A.;Rahman, Atif
背景：健康思维计划（THP）被建议用于在资源有限的环境中治疗围产期抑郁症，但由于社区卫生工作者的缺乏，该计划的推广受到阻碍。 THP 适合同行交付 (THPP)，并在印度和巴基斯坦的两项随机对照试验中进行了评估。我们的目的是评估 THPP 对这两种情况下孕产妇结局的有效性，并评估国家和其他预定义协变量的效应修正。方法：参与者是年龄 >= 18 岁的抑郁症孕妇（患者健康问卷 (PHQ-9) 评分 >= 10），随机接受 THPP 加强化常规护理 (EUC) 或仅 EUC。主要结局是产后 6 个月的症状严重程度和缓解（PHQ-9 评分 < 5）。次要结局包括产后 3 个月和 6 个月的抑郁、残疾和社会支持的进一步测量。结果：在 850 名女性（280 名印度；570 名巴基斯坦）中，704 名（83%）参加了 6 个月的随访。与仅使用 EUC 的参与者相比，干预组的参与者症状严重程度较低（PHQ-9 评分调整后平均差 -0.78（95% 置信区间 -1.47,-0.09）），缓解几率较高（调整后优势比 1.35 (1.02,1.78)）。对于患有短暂慢性抑郁症的女性和初产妇来说，干预对缓解效果更大。多个次要结局均具有有益的干预效果。局限性：这些试验没有能力评估效果修改。 10-20% 的参与者缺少结果数据。局限性：这些试验没有能力评估效果修改。 10-20% 的参与者缺少结果数据。 结论：这项汇总分析证明了 THPP 的有效性、可接受性和可行性，可以通过与现有医疗保健系统和社区合作，在分级护理方法中扩大 THPP 的规模，以解决资源有限环境中围产期抑郁症的治疗差距。
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.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.