A groundbreaking clinical trial funded by the National Institutes of Health has unveiled compelling results, demonstrating that an intervention aimed at alleviating anxiety in pregnant women residing in Pakistan significantly diminishes the likelihood of developing moderate-to-severe anxiety, depression, or both six weeks after childbirth. The trial, conducted between April 2019 and January 2022 in the Punjab Province of Pakistan, employed non-specialized providers with bachelor’s degrees in psychology but no clinical experience to administer the unique intervention. The findings offer promise for effectively preventing postpartum mental health challenges in women in low-resource settings.
“In low-resource settings, the accessibility of mental health care for women is hindered by a global shortage of trained specialists,” explained Joshua A. Gordon, M.D., Ph.D., Director of the National Institute of Mental Health. “This study underscores the potential of non-specialists to fill this critical gap and provide care to a larger number of women during this vital period.”
Led by Pamela J. Surkan, Ph.D., Sc.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study randomly assigned pregnant women displaying at least mild anxiety symptoms to receive routine pregnancy care or a cognitive-behavioral therapy (CBT)-based intervention named Happy Mother-Healthy Baby. The participants, totaling 380 women in the CBT group and 375 women in the routine care group, were evaluated for anxiety and depression six weeks post-childbirth.
Results revealed a significant difference in outcomes, with only 9% of women in the intervention group developing moderate-to-severe anxiety compared to 27% in the routine care group. Similarly, 12% of women in the intervention group experienced depression, in contrast to 41% in the routine care group.
“Postpartum depression not only harms mothers, but it is also associated with poorer physical growth and delayed cognitive development in their children,” emphasized Dr. Surkan. “The link between maternal and child health underscores the critical importance of developing effective ways to address postpartum anxiety and depression.”
The Happy Mother-Healthy Baby intervention, crafted with input from pregnant women in Rawalpindi, Pakistan, comprised six sessions where participants learned to identify anxious thoughts and behaviors. The program empowered women to replace such thoughts with helpful ones, targeting issues like possible miscarriage. Conducted during early to mid-pregnancy, the first five sessions were followed by a final session in the third trimester.
Given that up to 30% of women in the Global South report experiencing anxiety during pregnancy, this intervention holds particular significance. The prenatal period’s predictive link between anxiety during pregnancy and post-birth depression makes it a crucial target for intervention. The study’s findings indicate that Happy Mother-Healthy Baby could be a potent tool for preventing postpartum depression and anxiety in regions where accessing specialist clinical care is challenging.
“In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” concluded Dr. Surkan.
