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

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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.