Task-Shifting for Maternal Mental Health in Low Resource Settings: Challenges & Opportunities

On October 26th, 2021, Dr. Siham Sikander presented on recent, innovative interventions that have the potential to improve maternal mental health. This discussion was moderated by Dr. Lisa Bates, Vice Chair of Education and Assistant Professor at Columbia University.

Summary of Seminar:

Research has shown that task-shifting (training non-specialists to provide mental health care) is an effective strategy in improving mental health outcomes. Over a decade ago, Dr. Atif Rahman and Dr. Sikander, along with other study team members, developed an intervention in Pakistan to use cognitive behavioral therapy-based strategies to support for mothers with depression. This task-shifting intervention, called the Thinking Healthy Programme (THP), trained community health workers to provide psychological intervention for mothers with perinatal depression over a 12 month period. Due to its success, the Thinking Healthy Programme was then adopted and taken up by the World Health Organization as an intervention to be disseminated worldwide.

However, a challenge of expanding delivery of the Thinking Healthy Programmer (THP) was that many local community health workers’ workloads were already at capacity and thus would not be able to take on additional responsibilities to support community members. Due to this limitation in human resources, THP was adapted to become a peer-delivered intervention (THP-P). Local volunteers, who were respected members of the community and were slightly older, more experienced mothers, were recruited and trained to provide support to mothers experiencing depression post-partum. While testing this task-shifted THP-P intervention, the trial also grew into a cohort (Bachpan Cohort) in which a reference group of mothers who did not have depression also participated in the study. Futhermore, the intervention grew to providing support for mothers and children five years postnatal. More information about the Bachpan Cohort Study is available here.

Results of this ongoing research have indicated that peers are a feasible, acceptable, cost-effective resource who can support maternal mental health. The prevalence rate and severity of depression among mothers decreased at three months postnatal, but there were not significant differences in the long term (6 months postnatal, and 3 years postnatal) in the prevalence rates of depression (Vanobberghen et al., 2020; Sikander et al., 2019; Maselko et al., 2020). These findings indicate that some individuals may have chronic recurrent course of depression, and comprehensive support is needed for this group of mothers. Additionally, it is also important to recognize that sustaining a program over a long period of time is challenging (e.g. difficult to maintain fidelity in implementation and participant engagement), which impacts the outcomes of the intervention.

For the future, a Collaborative Care Program for maternal depression is being developed in order to provide more comprehensive psychosocial support for mothers, and ways to use technology to strengthen the fidelity of implementation are also being developed. 

The full recording of this University Seminar is available here.

More about the speaker: Dr. Siham Sikander is a global mental health academic with interest in developing and evaluating task-shifted, health systems based, maternal mental health interventions in low resource settings. Dr. Sikander is an Associate Professor at the Health Services Academy, Islamabad. He interfaces with the policy environment by being a member of the Health & Population Think Tank at the Federal Ministry of National Health Services, Islamabad. He is also affiliated with a not-for-profit research NGO called Human Development Research Foundation, Pakistan, as a Principal Scientist and a Mental Health Advisor.