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Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings

Perinatal depression is highly prevalent in low- and middle-income countries (LMICs) and is associated with adverse maternal and child health consequences. Task-shared psychological and psychosocial interventions for perinatal depression have demonstrated clinical and cost-effectiveness when deliver...

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Autores principales: Waqas, Ahmed, Sikander, Siham, Malik, Abid, Atif, Najia, Karyotaki, Eirini, Rahman, Atif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320748/
https://www.ncbi.nlm.nih.gov/pubmed/35887543
http://dx.doi.org/10.3390/jpm12071046
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author Waqas, Ahmed
Sikander, Siham
Malik, Abid
Atif, Najia
Karyotaki, Eirini
Rahman, Atif
author_facet Waqas, Ahmed
Sikander, Siham
Malik, Abid
Atif, Najia
Karyotaki, Eirini
Rahman, Atif
author_sort Waqas, Ahmed
collection PubMed
description Perinatal depression is highly prevalent in low- and middle-income countries (LMICs) and is associated with adverse maternal and child health consequences. Task-shared psychological and psychosocial interventions for perinatal depression have demonstrated clinical and cost-effectiveness when delivered on a large scale. However, task-sharing approaches, especially in LMICs, require an effective mechanism, whereby clients who are not likely to benefit from such interventions are identified from the outset so that they can benefit from higher intensity treatments. Such a stratified approach can ensure that limited resources are utilized appropriately and effectively. The use of standardized and easy-to-implement algorithmic devices (e.g., nomograms) could help with such targeted dissemination of interventions. The present investigation posits a prognostic model and a nomogram to predict the prognosis of perinatal depression among women in rural Pakistan. The nomogram was developed to deliver stratified model of care in primary care settings by identifying those women who respond well to a non-specialist delivered intervention and those requiring specialist care. This secondary analysis utilized data from 903 pregnant women with depression who participated in a cluster randomized, controlled trial that tested the effectiveness of the Thinking Healthy Program in rural Rawalpindi, Pakistan. The participants were recruited from 40 union councils in two sub-districts of Rawalpindi and randomly assigned to intervention and enhanced usual care. Sixteen sessions of the THP intervention were delivered by trained community health workers to women with depression over pregnancy and the postnatal period. A trained assessment team used the Structured Clinical Interview for DSM-IV current major depressive episode module to diagnose major depressive disorder at baseline and post-intervention. The intervention received by the participants emerged as the most significant predictor in the prognostic model. Among clinical factors, baseline severity of core-emotional symptoms emerged as an essential predictor, followed by atypical symptoms and insomnia. Higher severity of these symptoms was associated with a poorer prognosis. Other important predictors of a favorable prognosis included support from one’s mother or mother-in-law, financial empowerment, higher socioeconomic class, and living in a joint family system. This prognostic model yielded acceptable discrimination (c-statistic = 0.75) and calibration to aid in personalized delivery of the intervention.
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spelling pubmed-93207482022-07-27 Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings Waqas, Ahmed Sikander, Siham Malik, Abid Atif, Najia Karyotaki, Eirini Rahman, Atif J Pers Med Article Perinatal depression is highly prevalent in low- and middle-income countries (LMICs) and is associated with adverse maternal and child health consequences. Task-shared psychological and psychosocial interventions for perinatal depression have demonstrated clinical and cost-effectiveness when delivered on a large scale. However, task-sharing approaches, especially in LMICs, require an effective mechanism, whereby clients who are not likely to benefit from such interventions are identified from the outset so that they can benefit from higher intensity treatments. Such a stratified approach can ensure that limited resources are utilized appropriately and effectively. The use of standardized and easy-to-implement algorithmic devices (e.g., nomograms) could help with such targeted dissemination of interventions. The present investigation posits a prognostic model and a nomogram to predict the prognosis of perinatal depression among women in rural Pakistan. The nomogram was developed to deliver stratified model of care in primary care settings by identifying those women who respond well to a non-specialist delivered intervention and those requiring specialist care. This secondary analysis utilized data from 903 pregnant women with depression who participated in a cluster randomized, controlled trial that tested the effectiveness of the Thinking Healthy Program in rural Rawalpindi, Pakistan. The participants were recruited from 40 union councils in two sub-districts of Rawalpindi and randomly assigned to intervention and enhanced usual care. Sixteen sessions of the THP intervention were delivered by trained community health workers to women with depression over pregnancy and the postnatal period. A trained assessment team used the Structured Clinical Interview for DSM-IV current major depressive episode module to diagnose major depressive disorder at baseline and post-intervention. The intervention received by the participants emerged as the most significant predictor in the prognostic model. Among clinical factors, baseline severity of core-emotional symptoms emerged as an essential predictor, followed by atypical symptoms and insomnia. Higher severity of these symptoms was associated with a poorer prognosis. Other important predictors of a favorable prognosis included support from one’s mother or mother-in-law, financial empowerment, higher socioeconomic class, and living in a joint family system. This prognostic model yielded acceptable discrimination (c-statistic = 0.75) and calibration to aid in personalized delivery of the intervention. MDPI 2022-06-27 /pmc/articles/PMC9320748/ /pubmed/35887543 http://dx.doi.org/10.3390/jpm12071046 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Waqas, Ahmed
Sikander, Siham
Malik, Abid
Atif, Najia
Karyotaki, Eirini
Rahman, Atif
Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
title Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
title_full Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
title_fullStr Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
title_full_unstemmed Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
title_short Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
title_sort predicting remission among perinatal women with depression in rural pakistan: a prognostic model for task-shared interventions in primary care settings
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320748/
https://www.ncbi.nlm.nih.gov/pubmed/35887543
http://dx.doi.org/10.3390/jpm12071046
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