Thinking Healthy Programme (CBT by community health workers)
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.
- Intervention
- In this atlas
Overview
Technical summary
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.
About this intervention
- Type
- Service
- Mechanism
- Not reported
Claims and evidence
Context 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
- Infants at 6 months and 12 months of age
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Infant growth measured at 6 and 12 months (abstract).
Eligibility: 1 inclusion criterion; 1 exclusion criterion
- Included
- Infants of mothers enrolled in the trial
- Excluded
- Not stated in the abstract
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).
Applies to Child- 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.
- Community: infants of mothers who received visits from community-based primary health workers.
- Rural Rawalpindi, Pakistan
- Infants at 6 months and 12 months of age
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- 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.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (4)
-
- Locator
- Abstract, METHODS, sentence 4
- How it applies
- Primary outcomes were infant weight and height.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, FINDINGS, sentence 4, fragment 1 of 2
- How it applies
- Z scores and p values, part 1.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, FINDINGS, sentence 4, fragment 2 of 2
- How it applies
- Z scores and p values, part 2.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, METHODS, sentence 1
- How it applies
- Cluster design.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
Context 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
- Third trimester of pregnancy at entry; outcomes after birth.
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Maternal depression at 6 and 12 months (abstract).
Eligibility: 4 inclusion criteria; 1 exclusion criterion
- Included
- Married
- Aged 16 to 45 years
- Third trimester of pregnancy
- Perinatal depression
- Excluded
- Not stated in the abstract
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).
Applies to Maternal- 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.
- Community setting, run within the ordinary duties of community primary health workers (abstract).
- Rural Rawalpindi, Pakistan
- Third trimester of pregnancy at entry; outcomes after birth.
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- 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.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (12)
-
- Locator
- Abstract, METHODS, sentence 1
- How it applies
- Cluster design and setting.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, METHODS, sentence 2
- How it applies
- Who was eligible.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, METHODS, sentence 3, fragment 1 of 2
- How it applies
- The intervention, part 1.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, METHODS, sentence 3, fragment 2 of 2
- How it applies
- The control condition.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, METHODS, sentence 4
- How it applies
- Primary and secondary outcomes.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, METHODS, sentence 5
- How it applies
- Masking of interviewers.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, FINDINGS, sentence 1
- How it applies
- Clusters and mothers per group.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, FINDINGS, sentence 2, fragment 1 of 2
- How it applies
- Major depression at 6 months, part 1.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, FINDINGS, sentence 2, fragment 2 of 2
- How it applies
- Major depression at 6 months, part 2.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, FINDINGS, sentence 3
- How it applies
- Sustained at 12 months.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Abstract, INTERPRETATION, sentence 1
- How it applies
- Authors' interpretation.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
0641a7f04c96f5cf1280cbaf99498eaf035fdaf425a87743216b01a9ce0da444- 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.
-
- Locator
- Methods, Intervention and control groups, paragraph 1
- How it applies
- The full text names the intervention as the Thinking Healthy Programme.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
731ea43e77f0bde883c462eaa99860b0a16e455310e1f3454a64abdcd7f0b9fe- 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.
Clinical links
Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.
-
Claim, not a settled fact Cluster trial in rural Pakistan: major depression 23% against 53% at 6 months (secondary outcome): Perinatal depression (mother)
Applies to Maternal- 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.
- Community setting, run within the ordinary duties of community primary health workers (abstract).
- Rural Rawalpindi, Pakistan
- Third trimester of pregnancy at entry; outcomes after birth.
- Gestational age Not reported
- Postnatal age Not reported
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).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.
Record details
- Record id
maternal:thinking-healthy-programme- Content hash
d459333c7079733c8bc6bbe3ddbae2783429dd1d978d037e911fc8da1b312a90