NIH-funded study shows prenatal mental health support is effective for women living in low-resource settings
• Press release
Results of a large clinical trial funded by the National Institutes of Health show that an anxiety intervention delivered to pregnant women living in Pakistan significantly reduced the likelihood of women developing moderate to severe anxiety, depression, or both six weeks after delivery. the birth. The single intervention was delivered by lay providers who had the equivalent of a degree in psychology—but no clinical experience. The results suggest that this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.
“In low-resource settings, it can be difficult for women to access mental health care because of the global shortage of trained mental health professionals,” said Joshua A. Gordon, MD, Ph.D., Director of the National Institute of Mental Health , part of the NIH. “This study shows that non-specialists could help fill this gap by providing care to more women during this critical time.”
Led by Pamela J. Surkan, Ph.D., Sc.D. , of the Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab province of Pakistan between April 2019 and January 2022. Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive-based intervention behavioral therapy (CBT) called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.
The researchers found that 9% of women in the intervention group developed moderate to severe anxiety compared to 27% of women in the routine care group. In addition, 12% of women in the intervention group developed depression compared to 41% of women in the routine care group.
“Postpartum depression not only harms mothers, but is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr. Surkan. “The relationship between maternal and child health highlights the critical importance of developing effective treatments for postpartum anxiety and depression.”
The Happy Mother-Healthy Baby intervention was created using input from pregnant women at a hospital in Rawalpindi, Pakistan. Pregnant women participated in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and practice replacing them with helpful thoughts and behaviors. The first five sessions took place in early to mid-pregnancy and the sixth session took place in the third trimester.
Previous research shows that up to 30% of women in the Global South, which includes South America, Africa and most of southern Asia, report experiencing stress during pregnancy. Stress during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention. However, it can be difficult for women living in low-resource settings to access trained clinical care. The findings of this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialized clinical care may be difficult.
“Going forward, we can leverage these findings through applied research. Having identified an intervention that works, the next step is to discover the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr. Surkan.
Citation: Surkan, PJ, Malik, A., Perin, J., Atif, N., Rowther, A., Zaidi, A., & Rahman, A. (2024). Nonspecialist-delivered stress-focused cognitive behavioral therapy for the prevention of postpartum depression: A randomized, phase 3 trial. Nature Medicine. https://www.nature.com/articles/s41591-024-02809-x
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