ENHANCE: Scaling-up Care for Perinatal Depression through Technological Enhancements to the ‘Thinking Healthy Programme’

What are the aims of the project? Perinatal depression affects about one in five women in low- and middle-income countries and has huge human and economic costs. The condition can be treated effectively with ‘talking therapies’. However, the vast majority of women in low-income countries remain untreated because of serious lack of mental-health specialists to deliver such therapies. In our previous work, we have adapted talking therapies so these can be delivered by non-specialists in low-income settings. In order to make such interventions even more accessible to the larger population, we aim to develop and evaluate a digital Application (App) to facilitate delivery of a WHO-approved ‘talking therapy’, the Thinking Healthy Programme, through lay-women. The project will be conducted in Pakistan. We also aim to train researchers in Nepal, Bangladesh and Sri Lanka to conduct similar research in their settings. How will the project be carried out? Phase 1 - Development of the App: We have extensive knowledge of the content, methods of training, supervision and delivery of the Thinking Healthy Programme which was developed by our team. Building on this knowledge, we will develop the App by employing a Human-Centred Design, which places end-users at the heart of the process in 3 steps: a) identifying the requirements of lay-therapists and mothers; b) testing multiple prototypes on selected users, and; c) testing the final prototype in actual conditions. This phase will take about 18 months. Phase 2 - Evaluation of the App: We will then compare the effectiveness and ‘value-for-money’ of our new App-assisted Thinking Healthy Programme with routinely delivered programme in low socio-economic settings in Pakistan. All pregnant women from randomly picked villages, who score highly on a depression questionnaire, will receive one or the other intervention. We will then assess both groups at 3 and 6 months after childbirth for symptoms of depression and other health outcomes. We will interview some participants in more detail to understand the facilitators and barriers to the new way of intervention delivery. We will determine the costs associated with the programme to evaluate its ‘value-for-money’. This phase will take about 30 months. Phase 3 – Training of researchers in other countries of the region: In addition to Pakistan, junior or mid-career researchers from Nepal, Bangladesh, and Sri Lanka will be selected to undergo a specially-designed training programme in conducting research in perinatal mental health in their own settings. In total, 8 researchers will be trained. As part of their training, they will undertake research projects in areas which are thought to be critical for implementation of interventions for mental health. How will this project benefit the public? Ultimately, this project will lead to more women with perinatal depression in Pakistan and other low- and middle-income countries to receiving the treatment they need. In addition to developing innovative ways to deliver interventions, we plan to raise public awareness of perinatal depression and what can be done about it through our well-established South Asian Hub for Advocacy, Research, and Education in mental health, operating in all four countries since 2012. We will carry out community meetings where we will share the findings of our project. In Pakistan, we will incorporate our innovations into the ‘President’s Programme to Promote Mental Health of Pakistanis’. At the global level, we will work closely with the World Health Organization to incorporate our findings into the revised version of the Thinking Healthy Programme which will be disseminated to all member countries through the WHO’s flagship mental health gap action programme.