Discussion
anxiety, disability of mental disorders, depressive, depression, disability
PHYSICAL DISORDERS, RECRUITMENT, DISORDERS
Considering successful achievement of recruitment and randomization, low levels of attrition at follow-up, and successful on-line delivery of THP in group setting, our findings indicate this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was acceptable to the participating women. At a personal level, it helped increase their psychosocial well-being, and self-confidence, while at the family and community levels, it helped address maternal-infant and marital relationships and improved social support. Similar findings have been reported from South Asia, where THP was delivered by peers (local lay women) through individual and groups sessions [The quantitative findings showed small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm, despite our study not being powered to detect differences between intervention and control conditions. Our pilot further showed that it was feasible to recruit and randomize women to intervention and control arms despite COVID-19 related administrative challenges and related delays, attrition rates were low at follow-up and the online delivery of THP-BGV in group setting through pregnancy school nurses was successful.Our results add to the recent global review of evidence, conducted by the World Health Organisation (WHO), indicating moderate to strong effect sizes in favour of preventive interventions in reducing the severity of depressive and anxiety symptoms in the postnatal period [To fill this gap, we believe the findings from our pilot study are sufficient to warrant a fully powered, large scale trial to evaluate the effectiveness of the adapted THP-BGV. The THP-BGV targeted all expectant women. For added feasibility and cost-effectiveness, future studies might, in line with WHO recommendations, focus the intervention to women at high risk for depression, e.g., women who have anxiety symptoms or sub-clinical depression so that resources are targeted to those who are most in need.We found relatively low prevalence of perinatal depression in our sample (3.4%) compared to the rate of 19% indicated in a recent study in Turkey [The assessment tools used was well received and found helpful in raising women’s awareness about mental health and healthy life styles, as some participants stated during interviews. Epidemiological surveys from 15 countries showed mental disorders are as disabling as physical disorders. Higher disability of mental disorders compared to physical disorders was limited to disability in social and personal role functioning, rather than life activities [The THP-BGV was delivered by nurses trained in the intervention. The participants found them acceptable and formed a good therapeutic relationship. Our findings add to the existing evidence that using a task shifting approach is a feasible and acceptable approach to increasing access to mental health interventions, and may be less stigmatizing than mental health professionals [The group format of the intervention provided participants an opportunity to validate, share and learn from each other’s experience. In a systematic review and thematic synthesis of the qualitative literature, women from the UK, Canada, Japan, and Australia, reported being validated of their experiences in a confidential and nonjudgmental environment helpful [Our pilot study also identified barriers to participation in the study such as time constraints or lack of interest for the participants. Similar barriers have been reported in previous studies [The THP-BGV was delivered online, despite its convenience, accessibility, and flexibility, it might decrease the intervention effectiveness due to increased distractions, decreased participation, decreased facilitator control of the group, and difficulty to get feedback from the group required to tailor their sessions [