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INTERVENTION EFFECTS

What is the THPP intervention?

  • Starting in pregnancy and continuing through 3 years postpartum, the intervention consisted of 10 individual and 22 group sessions

  • Focused on peer-support, behavioral activation, and problem solving

  • Allowed participants to voice problems & share experiences with childcare

Lay peer delivering a group session.

The intervention had different effects on mothers and children. Toggle between the tabs below to investigate. ​

Clinical depression symptoms:

Our main finding: the intervention impact was strong at first but weakened over time, with small impacts persisting

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The graph shows:

  • a strong intervention impact in reducing clinical depression symptoms among Pakistani mothers

  • a lower level of depression at 36 months after birth for mothers in intervention group.

We measured depressive symptoms with the Structured Clinical Interview for DSM-IV Disorders (SCID), a binary indicator used to pinpoint mothers' current major depressive episode (MDE). 

Depressed mothers were placed into one of two groups: 

  • Control: received just enhanced usual care (EUC)

  • Intervention: received THPP+ and EUC 

We also had a group of non-depressed mothers that allowed us to determine how much excess risk of MDE the intervention could mitigate. 

Overall mental health and wellbeing:

Our main finding: the intervention had a persistent impact on mental health, functioning, and decision making/empowerment. 

"Maternal mental health" was measured through a composite indicator combining information from the Patient Health Questionnaire (PHQ-9), SCID, and Cohen Perceived Stress Scale (PSS).

  • PHQ-9: depression severity screening and monitoring tool 

  • PSS: self-report measure that monitors stress

Maternal functioning was measured via the WHO Disability Assessment Schedule (WHO-DAS), which evaulates one's ability to perform various activities of daily living.

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The graph shows an improvement in women's overall mental health and  functional status at 6, 12, and 36 months after birth compared to women in the control group

Biomarkers:

Our main finding: the intervention decreased cortisol and cortisone levels while increasing DHEA. 

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Cortisol is a hormone released by the HPA axis that helps us mediate our stress response; too much or too little can lead to disease (Thau et al., 2023)

Cortisone also plays an important role in the stress response: it can have toxic effects on neurodevelopment & immune functioning with prolonged exposure. 

DHEA has a regenerative role in the body. It has also been shown to play a protective role as an antagonist (blocker) of other stress hormones (Dutheil et al., 2021)

For mothers at 12 months after birth who received the intervention, the graph shows a reduction in cortisol and cortisone levels and an increase in DHEA.

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