The THP is a psychological intervention designed to address moderate to moderately severe perinatal depression. This intervention was carried out in urban clinical settings of a tertiary care hospital in Lahore, Pakistan. Administered by a trained non-specialist researcher to pregnant women in their second trimester, the primary goal was to mitigate the risk of postpartum depression. This study investigated demographic factors including age, participants’ and their husbands’ education level, employment status, and the age difference between partners. Notably, the intervention significantly alleviated depression symptoms among participants.
Similar studies have highlighted the adaptability of such interventions. For instance, research in India suggested that THP is particularly beneficial for women with a shorter history of depression, improving their perceived social support and reducing disability [15]. This aligns with global evidence indicating that non-specialist laywomen can effectively deliver primary psychological care in low-resource settings.
In this trial, the PHQ-9, an Urdu version validated for reliability and simplicity, was employed to screen for depressive symptoms before and after the intervention. The tool’s effectiveness is well-documented across several low-resource middle-income countries [16–18]. Our findings are consistent with broader research showing that psychological therapies can be effectively managed by lay workers in low-resource environments.
Demographic insights from our study revealed that participants and their spouses, being better educated and residing in urban areas, were more receptive to understanding and benefiting from the therapy. In Pakistan, where the majority of households are joint families with more than eight members and one to two dependents, family significantly influences the daily lives and mental health of pregnant women. These women, often preoccupied with family duties and predominantly overseen by their mothers-in-law, receive limited emotional support from their partners to discuss personal and health issues, potentially exacerbating depressive symptoms. The psychotherapy sessions offered a crucial opportunity for them to voice concerns about their health and family dynamics. Interestingly, a contrasting study in India found that this intervention did not yield enhanced benefits in similar well-educated and resourced environments [15], suggesting the influence of other contextual factors on the efficacy of the treatment.
A comparative study conducted in a rural community setting in Pakistan found that 93% of the pregnant women in the intervention group were homemakers, aligning with our findings where most women were similarly not employed. Notably, the intervention demonstrated a more significant effect in these non-working women. However, it was found that most mothers benefiting from the intervention had lower or secondary education [19]. In our study, a considerable number of participants possessed secondary or higher education and exhibited a positive response to the treatment. The THP employs behavioral activation techniques and is facilitated by lay workers. It has proven to be an effective, low-cost approach not only in reducing symptoms of perinatal depression but also in fostering recovery post-delivery. Additionally, it enhances social support and improves functional outcomes, thus contributing positively to public health [20].
Another study based on THP conducted in a rural community demonstrated significantly enhanced outcomes within three months postpartum, a critical period for maternal involvement in child healthcare [19]. This timing is crucial as it aligns with heightened demands on mothers’ mental and physical health. The findings advocate for the expansion of mental health services in clinical settings, even those lacking specialized mental health professionals. THP, which employs basic cognitive behavioral therapy techniques such as active listening, empathy, and non-judgmental support, can be effectively administered as front-line therapy for perinatal depression. These foundational skills facilitate the detection and modification of negative thoughts, pivotal in behavioral activation. Given its efficacy, THP should be tailored to meet individual needs and integrated into the health system through a collaborative care model, thus potentially enabling a broader recovery during the antenatal period and beyond [21].
Limitations
Our research was conducted at a tertiary care hospital in an urban, developed city characterized by a high literacy rate. However, the generalizability and acceptability of our psychological treatment findings may vary among populations in socioeconomically poorer regions with different healthcare systems. This study was self-funded and limited to a single institution, which restricted our sample size. Consequently, broader conclusions are constrained, and the results would benefit from a more extensive participant base. High dropout rates were noted, primarily due to challenges in obtaining permission from husbands or in-laws for women to discuss their personal and family issues. Additionally, our limited resources prevented long-term follow-up and the implementation of randomized controlled trials, which could have enhanced the robustness of our findings. Future research should focus on incorporating randomized trials to improve the generalizability and validity of the results.