Cited by 993Maternal Mental Health During Pregnancy and PostpartumMental Health Treatment and AccessMaternal and Neonatal Healthcare

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Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial

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Rahman, Atif, Malik, Abid, Sikander, Siham, Roberts, Christopher, Creed, Francis·2008·The Lancet

DOI 10.1016/s0140-6736(08)61400-2PMC PMC2603063

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Abstract

Background The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development. We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on maternal depression and infant outcomes.Methods We randomly assigned 40 Union Council clusters in rural Rawalpindi, Pakistan, in equal numbers to intervention or control. Married women (aged 16-45 years) in their third trimester of pregnancy with perinatal depression were eligible to participate. In the intervention group, primary health workers were trained to deliver the psychological intervention, whereas in the control group untrained health workers made an equal number of visits to the depressed mothers. The primary outcomes were infant weight and height at 6 months and 12 months, and secondary outcome was maternal depression. The interviewers were unaware of what group the participants were assigned to. Analysis was by intention to treat. The study is registered as ISRCTN65316374.Findings The number of clusters per group was 20, with 463 mothers in the intervention group and 440 in the control group. At 6 months, 97 (23%) of 418 and 211 (53%) of 400 mothers in the intervention and control groups, respectively, met the criteria for major depression (adjusted odds ratio (OR) 0.22, 95% CI 0.14 to 0.36, p<0.0001). These effects were sustained at 12 months (111/412 [27%] vs 226/386 [59%], adjusted OR 0.23, 95% CI 0.15 to 0.36, p<0.0001). The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months (-0.83 vs -0.86, p=0.7 and -2.03 vs -2.16, p=0.3, respectively) or 12 months (-0.64 vs -0.8, p=0.3 and -1.10 vs -1.36, p=0.07, respectively).Interpretation This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in resource-poor settings.

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Authors: Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F.
Affiliations: Human Development Research Foundation (PK)
University of Manchester (GB)
ORCID: Malik, Abid
Sikander, Siham
Roberts, Christopher
Creed, Francis
Venue: The Lancet
Publisher: Elsevier BV
Published: 2008-09
Volume: 372
Issue: 9642
Pages: 902-909
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(08)61400-2
PMC: PMC2603063
OpenAlex: W2128974992
Cited by: 993
References: 33
Citations by year: 2026: 45 · 2025: 48 · 2024: 43 · 2023: 65 · 2022: 83 · 2021: 73 · 2020: 60 · 2019: 68 · 2018: 66 · 2017: 56 · 2016: 48 · 2015: 75 · 2014: 64 · 2013: 64 · 2012: 37
FWCI: 31.99
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: The Lancet (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (publishedVersion)
Funders: Wellcome Trust
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
Keywords: perinatal depression, maternal depression, cognitive behavioral therapy, community health workers, primary health workers, psychological intervention, infant growth, rural Pakistan, Rawalpindi, third trimester, intervention sustainability, maternal mental health services
MeSH terms: Adolescent, Adult, Birth Weight, Community Health Workers, Depressive Disorder, Female, Humans, Infant, Newborn, Male, Maternal Age, Middle Aged, Pakistan, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Third, Social Class, Social Support, Cognitive Behavioral Therapy, Prevalence, Cluster Analysis, Outcome Assessment, Health Care

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Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial

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