Intervention Reduces Likelihood of Developing Postpartum Anxiety and Depression by More Than 70%
NIH-funded study shows prenatal mental health support is effective for women living in low-resource settings
• Press release
Results from a large clinical trial funded by the National Institutes of Health show that an anxiety intervention provided to pregnant women living in Pakistan significantly reduced the likelihood that the women would develop moderate to severe anxiety, depression, or both, six weeks after birth. The single intervention was administered by lay providers who had the equivalent of a bachelor’s degree in psychology, but no clinical experience. The results suggest that this intervention could be an effective way to prevent the development of postpartum mental health problems in women living in low-resource settings.
“In low-resource settings, it may be difficult for women to access mental health care due to a global shortage of trained mental health specialists,” said Joshua A. Gordon, M.D., Ph.D., Director of the National Institute of Mental Health. , part of the NIH. “This study shows that non-specialists could help fill this gap, providing care to more women during this critical period.”
Directed by Pamela J. Surkan, Ph.D., Sc.D. , from the Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab province of Pakistan between April 2019 and January 2022. Pregnant women with at least mild anxiety symptoms were randomly assigned to receive routine pregnancy care or a cognitive program. Intervention based on behavioral therapy (CBT) called Happy Mother-Healthy Baby. The researchers screened the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.
The researchers found that 9% of women in the intervention group developed moderate to severe anxiety compared to 27% of women in the routine care group. Additionally, 12% of women in the intervention group developed depression compared to 41% of women in the routine care group.
“Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” Dr. Surkan said. “The link between maternal and infant health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”
The Happy Mother-Healthy Baby intervention was created based on input from pregnant women in a hospital in Rawalpindi, Pakistan. Pregnant women participated in six intervention sessions in which they learned to identify anxious thoughts and behaviors, such as thoughts about a possible miscarriage, and practice replacing them with helpful thoughts and behaviors. The first five sessions took place between the first and mid-pregnancy and the sixth session took place in the third trimester.
Previous research suggests that up to 30% of women in the Global South, which includes South America, Africa and most of South Asia, report experiencing anxiety during pregnancy. Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a primary target for intervention. However, it may be difficult for women living in low-resource settings to access skilled clinical care. The findings of this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where it may be difficult to access specialized clinical care.
“In the future, we will be able to build on these findings through implementation research. Once an intervention that works is identified, the next step is to discover the best ways to provide effective treatment to people who need it, bridging the gap between science and practice,” said Dr. Surkan.
Reference: Surkan, PJ, Malik, A., Perin, J., Atif, N., Rowther, A., Zaidi, A. and Rahman, A. (2024). Anxiety-focused cognitive-behavioral therapy delivered by non-specialists to prevent postpartum depression: a phase 3 randomized trial. Nature medicine. https://www.nature.com/articles/s41591-024-02809-x
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