A simple cognitive behavioural therapy-based programme that can be delivered by ordinary village-based primary health workers can massively reduce depression in mothers in resource-poor settings. These are the conclusions of an Article in the Alma Ata Special Issue of The Lancet, authored by Professor Atif Rahman, University of Liverpool and Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Working in rural Rawalpindi, Pakistan, the research team trained the health workers in the 'Thinking Healthy Programme' (THP) which involved active listening, collaboration with the family, guided discovery (ie, style of questioning to both gently probe for family's health beliefs and to stimulate alternative ideas), and homework so that treated mothers could try out techniques learned between sessions. The study assessed infant height and weight at six and 12 months, and maternal depression.
In this cluster-randomised controlled trial, 463 mothers from 20 rural clusters were in the THP group and 440 from another 20 rural clusters were in the control group. Mothers in the control group were more than four times likely to be depressed than those given THP, at both six months and 12 months. There were no statistically significant differences in infant height and weight between the two groups, but infants in the THP group were less likely to have a diarrhoeal episode in the two weeks prior to follow-up and were more likely to complete immunisation. There was an increased uptake of contraceptives and greater frequency of play activities with the infant by both mothers and fathers in the THP group.
The authors conclude: "This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in resource poor settings."
Professor Atif Rahman, University of Liverpool and Alder Hey Children's NHS Foundation Trust, Liverpool, contact best by e-mail due to travel E) atif.rahman@liverpool.ac.uk
Full paper: http://press.thelancet.com/aamental.pdf
Journal
The Lancet