20.1 IMPROVING ACCESS TO PSYCHOSOCIAL INTERVENTIONS FOR PERINATAL DEPRESSION IN LOW- AND MIDDLE-INCOME COUNTRIES: LESSONS FROM THE FIELD

Objectives: Over 90% of women with perinatal depression in low- and middle-income countries do not receive treatment. Scale-up of evidence-based psychosocial interventions is a key challenge. We developed the Thinking Healthy Program (THP), a psychosocial intervention that can be delivered by nonspecialist providers such as community health workers in primary and secondary care settings. Methods: A number of trials have been conducted on the THP, which have established its effectiveness and cost-effectiveness in diverse settings. In the original trial based on 903 women, results at 6 months postnatal showed that 77% of intervened mothers (vs 47% of the nonintervened group) recovered from depression (adjusted OR = 0.22;95% CI, 0.14-0.36;p < 0.0001). This effect was sustained at 12 months postnatal. More recently, we pooled data from 2 new trials with a total of 850 women across Pakistan and India. Mothers in the intervention arm had higher odds of remission rates and lower symptom severity at 6 months postnatal compared to control mothers (adjusted OR = 1.35;95% CI, 1.02-1.78) (Patient Health Questionnaire-9 [PHQ-9] score adjusted mean difference = –0.78;95% CI, –1.47 to –0.09). All trials also showed improvements on a number of secondary outcomes including child outcomes. We synthesize and discuss the global lessons and implications of having shown that THP is effective in diverse settings and that the policy and practice uptake of the program globally has been promising. Results: We find that the THP is relatively inexpensive and culturally transferable;the intervention can be integrated with existing maternal and child health programs;the program is amenable to “task-sharing/task-shifting” via lay peers, nurses, community health workers, and other frontline workers;there are cascaded models of training and supervision;and the technology is used for training and delivery to provide exciting future avenues for scaled-up implementation. Conclusions: These innovations are relevant to the neglected field of public mental health, especially in the post–COVID-19 era when rates of anxiety and depression are likely to rise globally. DDD, INF, TREAT