Efficacy of the ‘Thinking Healthy Program’ in Alleviating Antenatal Depression Among Pregnant Women at a Tertiary Care Facility: A Quasi-Experimental Study Conducted in Pakistan

Category	Detail
Condition	Antenatal and postpartum depression
Key Mechanisms	Cognitive behavioural therapy-based intervention delivered by non-specialist health workers using active listening, family collaboration, guided discovery, and homework
Target Population	Pregnant women aged 18–45 years in the second trimester (24–26 weeks) with PHQ-9 scores > 10
Care Setting	Tertiary care hospital outpatient gynecology department in Pakistan

Postpartum depression prevalence in Pakistan is highest among Asian countries (28–63%) with many cases undiagnosed.
THP is a WHO-promoted, evidence-based, non-specialist-delivered psychological intervention effective in LMICs.
THP was tested in a tertiary care hospital setting for antenatal depression using PHQ-9 screening and showed potential to reduce depressive symptoms.

Screen pregnant women during antenatal visits using validated tools such as PHQ-9.
Identify women with PHQ-9 scores > 10 as at risk for antenatal depression.

Implement the Thinking Healthy Programme (THP) as a low-level psychological intervention for antenatal depression.
Deliver THP through trained non-specialist health workers integrated into routine maternal and child health education.

Perform baseline depression assessment in the second trimester (24–26 weeks).
Conduct follow-up evaluation within two weeks postpartum to assess intervention effectiveness.

Untreated antenatal depression increases risk of maternal suicide, infanticide, adverse obstetric outcomes, and impaired child development.
Lack of husband support, poor self-esteem, and young maternal age are notable risk factors.

Pregnant women aged 18–45 years in the second trimester with moderate to severe depressive symptoms (PHQ-9 > 10)

THP sessions delivered by non-specialists can reduce depressive symptoms and are feasible in tertiary care settings in LMICs like Pakistan.

Integrate mental health screening into routine antenatal care using standardized tools like PHQ-9.
Train non-specialist health workers in cognitive behavioural therapy techniques to deliver THP.
Engage family members in the intervention to enhance support and treatment adherence.
Use guided discovery and homework assignments to reinforce cognitive behavioural strategies.
Monitor depressive symptoms longitudinally from antenatal period through postpartum.

Clinical Scorecard: Efficacy of the ‘Thinking Healthy Program’ in Alleviating Antenatal Depression Among Pregnant Women at a Tertiary Care Facility: A Quasi-Experimental Study Conducted in Pakistan