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世界五分之一的妇女。大多数人生活在低收入和中等收入国家。这种情况不仅对母亲造成痛苦，而且对新生儿的生长和发育产生负面影响。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”。该疗法基于认知行为疗法的既定原则，帮助母亲及早识别抑郁症状，开展有助于控制这些症状的活动，并提供支持，以应对怀孕期间和分娩后常见的挑战。我们将随机分配接受治疗的妇女与参加常规妊娠“教育”小组的妇女进行比较，评估她们分娩后的抑郁症状和其他健康状况以及育儿措施。我们将在出生后6个月重复这些评估，看看是否会持续产生任何积极影响。我们将评估提供干预措施的成本与其收益。我们将探索这种疗法是如何起作用的，以便我们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，这将是首次在低收入和中等收入国家评估这种干预措施。世界卫生组织建议采取干预措施预防产后抑郁症，但认识到缺乏对中低收入国家的研究。我们的研究将表明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实的惠益。我们的项目还将协助这两个国家发展能力，以进行更复杂的研究，协助扩大这种干预措施。

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.