{
  "release_id": "c7fb95f1d15a7d13",
  "id": "maternal:thinking-healthy-programme",
  "owner": "maternal",
  "kind": "intervention",
  "slug": "thinking-healthy-programme",
  "name": "Thinking Healthy Programme (CBT by community health workers)",
  "aliases": [],
  "atlases": [
    "maternal"
  ],
  "summary_plain": "A programme in which community health workers are trained to deliver a form of cognitive behaviour therapy to mothers with depression around the time of birth. A published manual describes it. In a trial in rural Pakistan, fewer of the mothers who received it met the criteria for major depression at 6 and 12 months than mothers in the control group, but the babies' weight and height did not differ significantly.",
  "summary_technical": "A 2015 manual for psychosocial management of perinatal depression, the first volume of a series on low-intensity psychological interventions. A 2008 cluster-randomised trial in rural Rawalpindi, Pakistan, of a cognitive behaviour therapy based intervention delivered by community health workers had infant weight and height at 6 and 12 months as its primary outcomes, which did not differ significantly, and maternal depression as a secondary outcome, which was lower in the intervention group (97 of 418 against 211 of 400 at 6 months). See the two claims on this page. The full text of the trial paper calls its intervention the Thinking Healthy Programme: four weekly sessions in the final month of pregnancy, three in the first month after birth and then nine monthly ones, given by specially trained community health workers who used a training manual. The recipient is the pregnant or postpartum woman, and infant results are kept in their own context.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-14",
  "last_evidence_check": "2026-10-14",
  "next_review_due": null,
  "identifiers": [],
  "navigation": {
    "maternal": {
      "life-stage": [
        "pregnancy",
        "postpartum"
      ],
      "care-area": [
        "maternal-mental-health"
      ]
    }
  },
  "payload": {
    "subtype": "service",
    "mechanism": null,
    "components": null
  },
  "content_digest": "d459333c7079733c8bc6bbe3ddbae2783429dd1d978d037e911fc8da1b312a90",
  "review": {
    "content_digest": "d459333c7079733c8bc6bbe3ddbae2783429dd1d978d037e911fc8da1b312a90",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [
    {
      "release_id": "c7fb95f1d15a7d13",
      "id": "maternal:claim-thinking-healthy-infant-growth-pakistan",
      "owner": "maternal",
      "subject_entity_id": "maternal:thinking-healthy-programme",
      "category": "effect",
      "statement": "The primary outcomes of the same trial, infant weight and height at 6 and 12 months, did not differ significantly between the two groups. Weight-for-age Z scores for the two groups were -0.83 and -0.86 at 6 months (p=0.7) and -0.64 and -0.8 at 12 months (p=0.3); height-for-age Z scores were -2.03 and -2.16 at 6 months (p=0.3) and -1.10 and -1.36 at 12 months (p=0.07).",
      "context": {
        "id": "maternal:ctx-infants-of-depressed-mothers-rural-rawalpindi-pakistan",
        "label": "Infants of depressed mothers in rural Rawalpindi, Pakistan, weight and height at 6 and 12 months (2008)",
        "recipient": "child",
        "population": "Infants born to the mothers in the same trial. The main outcomes were the infant's weight and height at 6 and 12 months, expressed as Z scores for weight for age and for height for age.",
        "care_setting": "Community: infants of mothers who received visits from community-based primary health workers.",
        "geography": "Rural Rawalpindi, Pakistan",
        "life_stage_note": "Infants at 6 months and 12 months of age",
        "life_stage_terms": {
          "maternal": [
            "infant-follow-up"
          ]
        },
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Infant growth measured at 6 and 12 months (abstract).",
        "eligibility": {
          "inclusion": [
            "Infants of mothers enrolled in the trial"
          ],
          "exclusion": [
            "Not stated in the abstract"
          ]
        }
      },
      "evidence_stage": "interventional",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "Only the PubMed abstract was read, and it does not say which value belongs to which group. A difference that is not statistically significant is not proof of no effect. The infants were of mothers with depression in a rural district of Pakistan. Infant outcomes belong to the infant context and are kept apart from the maternal depression result.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 4",
          "applicability_note": "Primary outcomes were infant weight and height.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, FINDINGS, sentence 4, fragment 1 of 2",
          "applicability_note": "Z scores and p values, part 1.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, FINDINGS, sentence 4, fragment 2 of 2",
          "applicability_note": "Z scores and p values, part 2.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "context",
          "locator": "Abstract, METHODS, sentence 1",
          "applicability_note": "Cluster design.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        }
      ],
      "review": {
        "content_digest": "14219ac4367b9ca400d86a1ff875cfc210c36c5ed25695a9a9785247a26397ac",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/maternal--claim-thinking-healthy-infant-growth-pakistan.json"
    },
    {
      "release_id": "c7fb95f1d15a7d13",
      "id": "maternal:claim-thinking-healthy-maternal-depression-pakistan",
      "owner": "maternal",
      "subject_entity_id": "maternal:thinking-healthy-programme",
      "category": "effect",
      "statement": "In a cluster-randomised trial in rural Rawalpindi, Pakistan, with 20 clusters per group (463 mothers in the intervention arm, 440 in the control arm), trained community-based primary health workers delivered a cognitive behaviour therapy based intervention to mothers with depression in the third trimester, while untrained health workers made the same number of visits in the control arm. At 6 months, 97 (23%) of 418 mothers in the intervention group and 211 (53%) of 400 in the control group had major depression by the trial's criteria (adjusted odds ratio 0.22, 95% CI 0.14 to 0.36, p<0.0001). The difference was sustained at 12 months: 111 of 412 (27%) against 226 of 386 (59%), adjusted odds ratio 0.23 (95% CI 0.15 to 0.36).",
      "context": {
        "id": "maternal:ctx-depressed-mothers-rural-rawalpindi-pakistan",
        "label": "Married women aged 16 to 45 years with perinatal depression in the third trimester, rural Rawalpindi, Pakistan (2008)",
        "recipient": "maternal",
        "population": "Married women aged 16 to 45 years who were depressed in the last three months of pregnancy, drawn from 40 Union Council clusters across rural Rawalpindi in Pakistan, allocated in equal numbers to intervention or control. The intervention group had 463 mothers and the control group 440.",
        "care_setting": "Community setting, run within the ordinary duties of community primary health workers (abstract).",
        "geography": "Rural Rawalpindi, Pakistan",
        "life_stage_note": "Third trimester of pregnancy at entry; outcomes after birth.",
        "life_stage_terms": {
          "maternal": [
            "pregnancy",
            "postpartum"
          ]
        },
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Maternal depression at 6 and 12 months (abstract).",
        "eligibility": {
          "inclusion": [
            "Married",
            "Aged 16 to 45 years",
            "Third trimester of pregnancy",
            "Perinatal depression"
          ],
          "exclusion": [
            "Not stated in the abstract"
          ]
        }
      },
      "evidence_stage": "interventional",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "Maternal depression was a secondary outcome. The trial's main outcomes were the infant's weight and height at 6 and at 12 months, and those did not differ significantly (separate claim). The abstract was read in PubMed and the full text in PubMed Central. According to the full text, participants were aware only that the visits came in two types, and the abstract says the interviewers were unaware of group assignment; the health workers could not be masked. The trial was in one rural district of Pakistan, so the result may not carry over to other settings. The full text of the paper has no licence statement the atlas could use, so the public page states its facts in the atlas's own words.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 1",
          "applicability_note": "Cluster design and setting.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 2",
          "applicability_note": "Who was eligible.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 3, fragment 1 of 2",
          "applicability_note": "The intervention, part 1.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 3, fragment 2 of 2",
          "applicability_note": "The control condition.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 4",
          "applicability_note": "Primary and secondary outcomes.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, METHODS, sentence 5",
          "applicability_note": "Masking of interviewers.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, FINDINGS, sentence 1",
          "applicability_note": "Clusters and mothers per group.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, FINDINGS, sentence 2, fragment 1 of 2",
          "applicability_note": "Major depression at 6 months, part 1.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, FINDINGS, sentence 2, fragment 2 of 2",
          "applicability_note": "Major depression at 6 months, part 2.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, FINDINGS, sentence 3",
          "applicability_note": "Sustained at 12 months.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "context",
          "locator": "Abstract, INTERPRETATION, sentence 1",
          "applicability_note": "Authors' interpretation.",
          "snapshot": {
            "id": "maternal:pubmed-18790313-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:21Z",
            "content_hash": "0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pubmed-10-1016-s0140-6736-08-61400-2",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://doi.org/10.1016/S0140-6736(08)61400-2",
            "identifiers": [
              {
                "scheme": "doi",
                "value": "10.1016/S0140-6736(08)61400-2",
                "normalized_value": "10.1016/s0140-6736(08)61400-2",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "18790313",
                "normalized_value": "18790313",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmcid",
                "value": "PMC2603063",
                "normalized_value": "PMC2603063",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": "2008-09-13",
            "publisher": "Lancet (London, England)",
            "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.",
            "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Methods, Intervention and control groups, paragraph 1",
          "applicability_note": "The full text names the intervention as the Thinking Healthy Programme.",
          "snapshot": {
            "id": "maternal:pmc-pmc2603063-2026-10-14",
            "retrieved_at": "2026-10-14T18:18:22Z",
            "content_hash": "731ea43e77f0bde883c462eaa99860b0a16e455310e1f3454a64abdcd7f0b9fe",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "maternal:pmc-pmc2603063",
            "source_type": "publication",
            "title": "Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial",
            "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2603063/",
            "identifiers": [],
            "publication_date": null,
            "publisher": "Lancet",
            "edition": "PMC Open Access subset full-text XML, from NCBI E-utilities.",
            "reuse_basis": "PMC Open Access subset article, but its licence (none stated) is not one this tool treats as redistributable (CC0, CC BY, CC BY-SA, CC BY-ND). Only the hash of the bytes is kept. Short quotations under 25 words.",
            "public_text": "cite_only"
          }
        }
      ],
      "review": {
        "content_digest": "e229270264f068799e33786686c9201d2a82826491d79bea2bdf675ca927b524",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/maternal--claim-thinking-healthy-maternal-depression-pakistan.json"
    }
  ],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "evaluated_for",
        "label": "Cluster trial in rural Pakistan: major depression 23% against 53% at 6 months (secondary outcome)",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "maternal:perinatal-depression",
        "other_entity_in_atlas": true,
        "claim_id": "maternal:claim-thinking-healthy-maternal-depression-pakistan",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "WHO publication page for the Thinking Healthy manual",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "maternal:who",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "part_of",
        "label": "Filed under this front",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "maternal:front-mental-health-and-support",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": true,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": []
  },
  "page_path": "interventions/thinking-healthy-programme/",
  "context_path": "api/v1/context/maternal--thinking-healthy-programme.md"
}