Determinant factors and coping strategies for depression among pregnant women: an intervention-based qualitative study in Lahore, Pakistan

Abstract

Background: The present study is an intervention-based qualitative study that explores the factors causing depression among antenatal women and analyses coping strategies based on the modified version of the Thinking Healthy Programme (THP) intervention in the urban setting of Lahore, Pakistan. Methods: An exploratory qualitative evaluation approach was used in the present study. The study comprises four phases, i.e., the screening phase, exploratory phase, intervention phase, and evaluation phase. During the first phase, pregnant women aged 18–45 years were screened for anxiety and depression by using the Urdu-translated Patient Health Care Questionnaire-9. In the second phase, identified women were interviewed to explore the factors responsible for depression. In the third phase, the intervention was administered via the THP intervention. In the last phase, the same women were reinterviewed to analyse the outcomes of the intervention. Thematic analysis was performed for the analysis of the interviews. Results: Data was analyzed using thematic analysis following an deductive and indictive approach in both pre- and post-intervention phase. Three main themes emerged in the pre-intervention phase: (1) the impact of adverse life events on the mental health of pregnant women, (2) the adverse effects of marital relationship issues on pregnant women, and (3) depression-causing factors due to the joint family system. Furthermore, four themes emerged in the post-intervention stage: (1) development of positivity in thinking and attitude, (2) learning about stress management through the provision of compassion and sharing avenues, (3) gaining self-esteem to address matters positively, and (4) improving relationships with the unborn child and family. Numerous pregnant women praised the THP project and recommended that hospitals adopt it to assist pregnant patients in the Pakistani health system. Conclusion: The study concludes that THP can be a valuable tool for helping many pregnant women who are experiencing prenatal depression recover, however, there is a further need for exploring its benefits in varying social and cultural contexts. Trial registration: The study has been registered at https://clinicaltrials.gov/ (NCT04663243).