Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: pooled analysis of two randomized controlled trials in India and Pakistan

Fiona Vanobberghen, Helen A. Weiss, Daniela C. Fuhr, Siham Sikander, Ejma Afonso, Ikhlaq Ahmad, Najia Atif, Amina Bibi, Tayyaba Bibi, Samina Bilal, Aveena De Sa, Ethel D'Souza, Akankasha Joshi, Priya Korgaonkar, Revathi Krishna, Anisha Lazarus, Rakshanda Liaqat, Maria Sharif, Benedict Weobong, Ahmed ZaidiShaffaq Zuliqar, Vikram Patel, Atif Rahman

Research output: Contribution to journalArticleResearchpeer-review

15 Citations (Scopus)


Background: The Thinking Healthy Programme (THP) is recommended to treat perinatal depression in resource-limited settings, but scale-up is hampered by a paucity of community health workers. THP was adapted for peer-delivery (THPP) and evaluated in two randomized controlled trials in India and Pakistan. Our aim was to estimate the effectiveness of THPP on maternal outcomes across these two settings, and evaluate effect-modification by country and other pre-defined covariates. Methods: Participants were pregnant women aged≥18 years with depression (Patient Health Questionnaire (PHQ-9) score≥10), randomized to THPP plus enhanced usual care (EUC) or EUC-only. Primary outcomes were symptom severity and remission (PHQ-9 score<5) 6 months post-childbirth. Secondary outcomes included further measures of depression, disability and social support at 3 and 6 months post-childbirth. Results: Among 850 women (280 India; 570 Pakistan), 704 (83%) attended 6-month follow-up. Participants in the intervention arm had lower symptom severity (PHQ-9 score adjusted mean difference -0.78 (95% confidence interval -1.47,-0.09)) and higher odds of remission (adjusted odds ratio 1.35 (1.02,1.78)) versus EUC-only. There was a greater intervention effect on remission among women with short chronicity of depression, and those primiparous. There were beneficial intervention effects across multiple secondary outcomes. Limitations: The trials were not powered to assess effect-modifications. 10–20% of participants were missing outcome data. Conclusions: This pooled analysis demonstrates the effectiveness, acceptability and feasibility of THPP, which can be scaled-up within a stepped-care approach by engaging with the existing health care systems and the communities to address the treatment gap for perinatal depression in resource-limited settings.

Original languageEnglish
Pages (from-to)660-668
Number of pages9
JournalJournal of Affective Disorders
Publication statusPublished - 15 Mar 2020
Externally publishedYes


  • Community health workers
  • Depression
  • India
  • Pakistan
  • Patient health questionnaire
  • Pregnancy

Cite this