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What is the peer-delivered Thinking Healthy 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


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.


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


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


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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