Addressing Perinatal Depression in Deprived Areas of Istanbul, Turkey

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Why is it important to address depression in women during pregnancy Worldwide, depression during pregnancy affects about one in four women. The situation is similar in Turkey. The majority of these women do not receive any treatment. Untreated depression causes great suffering not only to the woman, but also affects the relationship between the mother and infant. It can lead to impaired brain development and poor growth in the infant in the long-term. Timely treatment can prevent these complications. Perinatal depression be treated effectively with 'talking therapies'. One of the most effective talking therapies, the Thinking Healthy Programme, was developed by Rahman and his team in Pakistan. The programme was adopted by the World Health Organization as its official first-line treatment for perinatal depression. However, the programme was developed for close-knit rural communities and delivered individually to rural women by community health workers. In big cities like Istanbul, rapid migration from rural areas can lead to breakdown of traditional family and community support which may increase the risk of depression. In High Income countries, group therapies have been shown to be effective and deliverable at lower cost. These may also be very useful for communities in which support networks are disrupted. There is currently no group version of the Thinking Healthy Programme. Objectives of the projectThe objectives of this project are two-fold:Objective 1. To adapt the well-established WHO Thinking Healthy Programme so it can be delivered to groups of women in deprived urban areas of Istanbul and to test the programme in selected antenatal hospitals in deprived districts of the city. Objective 2. To build capacity of researchers at Marmara University so they can undertake future large-scale studies in this important but neglected area of public health. How will we address our objectivesThe study will be conducted in 6 public hospitals serving low socioeconomic districts in Istanbul. These hospitals run regular antenatal classes for women from very poor backgrounds. We will integrate our intervention in these hospitals. Objective 1: This will be achieved in two phase. In the formative phase, we will talk to groups of all key stakeholders, including women, their partners and nurses who deliver the intervention. We will hold a workshop with local specialists and experts to adapt the intervention to the group-delivery format. In the feasibility phase, we will compare the adapted 'group' Thinking Healthy programme (intervention) with routine Antenatal classes (control). Both interventions will be delivered to 120 women, randomly divided into intervention and control groups. Our aim is to explore if the new intervention is feasible and acceptable to all our stakeholders, the training and supervision procedures work, and to test the tools required a future large-scale studies. We will use both qualitative and quantitative methods to explore these issues.Objective 2: Through our previous work in South Asia, we have developed a special course to train new researchers in designing and evaluating interventions for mental health in low and middle income countries. We will conduct two workshops aimed at training researchers at Marmara University in this comprehensive course. The content of the course includes design, implementation, monitoring and evaluation of interventions in low- and middle-income countries. How we will use the results of our projectWe will work closely with the World Health Organization to incorporate our findings into the revised 'group' version of the Thinking Healthy Programme which will be disseminated to all member countries through the WHO's flagship mental health gap action programme. Our partners at Marmara University are ideally placed to scale-up the intervention to other districts in Istanbul. We will publish papers in journals and present at conferences.