Randomised evaluation of a preventive intervention for postnatal depression in high-risk populations in Pakistan and Turkey: PREVENT-PND

产后抑郁症或分娩后抑郁症影响着全球五分之一的妇女。大多数人生活在低收入和中等收入国家。这种情况不仅给母亲带来痛苦，而且对新生儿的生长发育也有负面影响。因此，预防产后抑郁症至关重要。基于我们在巴基斯坦和土耳其进行的准备工作，我们的目标是在这两个国家对大约650名妇女进行一项大型研究，以测试在怀孕期间向妇女群体提供的“谈话疗法”。该疗法以认知行为疗法的既定原则为基础，帮助母亲及早认识抑郁症的症状，开展有助于控制这些症状的活动，并为处理怀孕期间和分娩后常见的挑战提供支持。我们将比较随机分配的接受治疗的妇女与参加常规妊娠“教育”小组的妇女，评估她们分娩后的抑郁症状和其他福祉和儿童保育措施。我们将在出生6个月后重复这些评估，看看是否有任何积极的影响持续下去。我们将评估提供干预的成本和收益。我们将探索这种疗法是如何起作用的，这样我们就可以在未来改进这种干预措施。如果我们提出的干预措施在预防抑郁症方面取得成功，这将是此类干预措施首次在低收入和中等收入国家进行评估。世界卫生组织建议采取干预措施预防产后抑郁症，但承认缺乏对中低收入国家的研究。我们的研究将展示如何将这些干预措施纳入妇女保健方案，不仅在巴基斯坦和土耳其，而且在全世界为妇女及其新生儿带来真正的好处。我们的项目还将帮助两国发展开展更复杂研究的能力，从而有助于扩大此类干预措施的规模。

Postnatal depression, or depression after childbirth, affects one in five women worldwide. The majority live in low- and middle-income countries (LMICs). The condition causes suffering not only to the mother, but has negative effects on the growth and development of the new-born. It is therefore vitally important to prevent postnatal depression. Building on our preparatory work conducted in Pakistan and Turkey, we aim to conduct a large study of about 650 women in the two countries to test a 'talking therapy' delivered to groups of women during pregnancy. The therapy is based on established principles of cognitive behaviour therapy and helps the mothers recognise symptoms of depression early, undertake activities that help keep such symptoms in check, and offers support to deal with commonly encountered challenges during pregnancy and after childbirth. We will compare randomly assigned women who receive the therapy with women who attend routine pregnancy 'educational' groups, assessing them for symptoms of depression and other well-being and childcare measures after they have given birth. We will repeat these assessments 6 months after birth to see if any positive effects are sustained. We will evaluate the costs of delivering the intervention versus its benefits. We will explore how the therapy works, so that we can improve such interventions in the future. If our proposed intervention is successful in preventing depression, it will be the first time such an intervention has been evaluated in low- and middle-income countries. The World Health Organization recommends interventions to prevent postnatal depression but recognises the lack of research in LMICs. Our study will show the way in which such interventions can be incorporated into programmes for women's health, and achieve real benefits for women and their new-borns not only in Pakistan and Turkey, but across the world. Our project will also assist in developing capacity in the two countries to conduct more sophisticated research that can assist with the scale-up of such interventions.