Tarannum, Rehenuma (2018) A pilot randomised controlled trial of a peer-based low-intensity psychosocial intervention for reducing depressive symptoms in pregnant women in rural Bangladesh. PhD thesis, Victoria University.

Abstract

Antepartum depression or depression during pregnancy is a significant public health concern because of its adverse impact on maternal and child health. Nearly 50% of pregnant women suffer from depressive symptoms and the rate is significantly higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). Despite the high prevalence of antepartum depressive symptoms among pregnant women in LMICs, many women have limited or no access to mental health care facilities in these regions. In light of these problems, the aim of this pilot study was to examine whether participation in a peer-based low-intensity psychosocial intervention had any effect on mild-to-moderate depressive symptoms in pregnant women residing in a low-resource setting in rural Bangladesh. A mixed method approach was used in this early intervention study to evaluate the intervention, with a pilot randomised controlled trial (RCT) and a process evaluation. The study participants were 70 pregnant women and five peers from a rural sub-district of Bangladesh, randomised into control and intervention groups. The intervention group received the intervention delivered by the peers for five weeks. The intervention was the antenatal part of the Thinking Healthy Programme–Peer delivered. Data were collected at baseline, post-intervention and four weeks after completion of the intervention. In addition, intervention group participants and peers were interviewed as part of a process evaluation. The findings of the study showed that at post-intervention, the intervention group had a significant decrease in depressive symptoms and a slight increase in self-esteem and perception of quality of life compared with the control group. The improvement in these parameters was more significant at post-intervention than at 4-week follow-up. The process evaluation indicated that the women perceived that taking part in the study was helpful in reducing their depressive symptoms and they were also satisfied with the peers delivering the programme. Peers were motivated to become involved in the project because they thought it was an excellent opportunity to learn new knowledge and skills, and because of their altruistic desire to help others. While the effectiveness of the peer-based intervention needs to be established in a large RCT, the outcomes of this study provide preliminary evidence, context and direction for implementation of an effective, low-cost, feasible, evidence-based intervention in primary health care settings in LMICs like Bangladesh.

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