Date of Award

Summer 2020

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

First Advisor

Ronnie D. Horner

Abstract

Maternal depression is often undetected or undertreated at the primary care level. Despite the growing high prevalence of depression among women of childbearing age, the usual primary care practice in Pakistan does not include depression screening. Two facility-based cluster randomized control trials, including a maternal depression intervention component, were conducted within two healthcare settings, private and public primary care facilities in Rawalpindi and Lahore. This study aimed to estimate the effectiveness of each trial in reducing maternal depression among mothers in the intervention arm compared to the control by analyzing the change in PHQ-9 (Patient Health Questionnaire-9) scores from baseline to endpoint. It also aimed to evaluate the intervention implementation process in both health care settings using in-depth interviews. The intervention arm clusters at private clinics showed a significant reduction in the mean PHQ-9 scores compared to the control, -2.27 (95% CI: 1.90, -2.68; p=0.000). Similarly, the difference of the change in PHQ-9 scores between intervention and control arm clusters at public facilities was also significant, -1.62 (95% CI: -2.24, -0.99; p

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