Abstract

Perinatal depression is a significant public health concern, affecting nearly 25% of women in low- and middle-income countries (LMICs). Despite the efficacy of behavioral therapy, a critical shortage of trained mental health specialists in these regions creates substantial treatment gaps. This research-in-progress project investigates an information systems solution to overcome this shortage by delivering specialist therapy remotely via digital platforms. We propose a Randomized Controlled Trial (RCT) to evaluate the effectiveness of this digitally mediated delivery approach. The study leverages the EZShifa digital health infrastructure (Hawwa Clinics) installed in low-income areas in Pakistan. These clinics integrate telemedicine and digital health tools to facilitate remote specialist consultations, effectively extending care to underserved populations by virtually transporting specialized healthcare expertise. The study will enroll approximately 500 perinatal women visiting a digital antenatal clinic. Participants will be randomly assigned to either a treatment arm or a control arm (standard care). The treatment arm will receive therapist-delivered behavioral sessions via the digital clinic. We will also explore a dose-response relationship by comparing participants receiving a single session versus those receiving repeated encounters. Primary outcomes are changes in depression and anxiety scores, measured by a modified Edinburgh Postnatal Depression Scale (EPDS), assessed at baseline, antenatally, and postnatally. Secondary outcomes include household interaction and socioeconomic stress. This study evaluates the efficacy and dose-response of remotely delivered therapy and utilizes digital integration for real-time randomization and data capture. The findings will inform the feasibility and scalability of using digital platforms to extend specialist mental health care to low-resource settings, potentially transforming service delivery where physical access is restricted.

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