Efficacy of the Thinking Healthy Program in Reducing Antenatal Depression in Pakistan

Overview

This quasi-experimental study evaluated the effectiveness of the Thinking Healthy Programme (THP), a cognitive behavioral therapy-based intervention, in reducing antenatal depression among pregnant women at a tertiary care hospital in Lahore, Pakistan. Results demonstrated significant alleviation of depressive symptoms following THP sessions delivered by non-specialist health workers during routine antenatal visits.

Background

Postpartum depression is a common and underdiagnosed condition in low- to middle-income countries, affecting up to 63% of women in Pakistan, the highest prevalence among Asian countries. It adversely impacts maternal and child health, including risks of maternal suicide, infant health complications, and impaired child development. Psychological interventions like THP, delivered by non-specialists, offer a promising approach to address the scarcity of mental health resources in such settings. This study aimed to assess THP's effectiveness in an urban tertiary care hospital context, where it had not previously been tested.

Data Highlights

The study enrolled pregnant women aged 18–45 years at 24–26 weeks gestation with PHQ-9 scores > 10. Baseline depression was assessed using PHQ-9, with follow-up evaluation within two weeks postpartum. The intervention incorporated cognitive behavioral techniques delivered by trained non-specialist health workers. The study was conducted over seven months at Sheikh Zayed Hospital Lahore, Pakistan.

Key Findings

• THP significantly reduced antenatal depressive symptoms among pregnant women with baseline PHQ-9 scores > 10.
• Non-specialist health workers effectively delivered the intervention integrated into routine antenatal care.
• The intervention utilized cognitive behavioral therapy principles including active listening, family collaboration, guided discovery, and homework.
• THP was feasible and acceptable in a tertiary care hospital setting in an urban Pakistani population.
• Screening with PHQ-9 enabled identification of at-risk women for targeted intervention during pregnancy.

Clinical Implications

Implementing THP in routine antenatal care can bridge the mental health treatment gap in resource-limited settings by empowering non-specialist health workers to deliver effective psychological interventions. Early identification and treatment of antenatal depression may improve maternal and neonatal outcomes and reduce the intergenerational impact of maternal depression. Policymakers should consider integrating THP into maternal health programs in tertiary care facilities in Pakistan and similar LMIC contexts.

Conclusion

The Thinking Healthy Programme is an effective, feasible intervention to alleviate antenatal depression when delivered by non-specialists in tertiary care settings. Its integration into routine antenatal services offers a scalable strategy to address the high burden of perinatal depression in Pakistan.

References

1. Rahman et al. 2008 -- Thinking Healthy Programme: A Cognitive Behaviour Therapy-Based Intervention for Perinatal Depression
2. World Health Organization 2016 -- mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings
3. Khan et al. 2020 -- Prevalence and Risk Factors of Postpartum Depression in Pakistan