Evaluating the Impact of Group Interpersonal psychotherapy (IPT) In Lebanon and Kenya on child developmental outcomes, maternal Depression and the mother-child relationship

Research Question: Does culturally-adapted group IPT delivered in community settings in Kenya and Lebanon have a greater impact on child developmental outcomes, maternal depression and the mother-child relationship than high quality standard care?

Background: Postnatal depression (PND) is a serious, disabling mental health condition affecting between 18-25% of women postnatally in low and middle income countries (LMICs). This is nearly twice the rate in high income countries, yet their needs are under-served.

Extensive evidence shows that maternal depression is consistently associated with adverse impacts on caregiving and on children s cognitive and socio-emotional development.

Our proposed research programme in Kenya and Lebanon will address the currently limited evidence concerning effective interventions to treat PND in LMICs and test whether a WHO-recommended psychological therapy modified to match local priorities, delivered sustainably with fidelity within existing healthcare systems, can lead to improvements in key measures of early child development alongside improvements in maternal mental health.

Aims and objectives: 1) develop a systematic understanding of how local communities perceive postnatal depression, 2) use this learning to work with experienced local practitioners to adjust group IPT to optimise cultural appropriateness, 3) use local clinical and community intelligence and policy support to identify optimal systems for screening women for PND, 4) train local workers to deliver adapted g-IPT, 5) undertake a feasibility RCT to assess the feasibility of critical elements of a trial to evaluate g-IPT, 6) if feasibility is demonstrated, test the effectiveness of g-IPT+ to promote child development and treat maternal depressive symptoms and estimate cost effectiveness, 7) work with communities, practitioners and policy makers to embed sustainable care pathways for postnatal depression and g-IPT+ treatment, and develop a toolkit to support training and implementation in other countries around the globe.

Methods: We propose a three-phase study: 1) phase 1 consists of study set up, context mapping and intensive local qualitative research to understand cultural factors related to postnatal depression and its treatment, 2) phase 2 is a feasibility clinical trial alongside qualitative research on protocol suitability, 3) phase 3 is a two-site individually randomised superiority trial of culturally adapted g-IPT+ versus High-Quality Standard Care for women with postnatal depression in Beirut, Lebanon and Nairobi, Kenya (N=412).

The population will be women with postnatal depression (PHQ-9) and an infant aged 6-35 weeks. Exclusion criteria include psychotic disorders, severe health conditions and imminent suicide risk. Primary outcome: child cognitive development at 12-month follow-up. Secondary outcomes include: maternal responsive caregiving and depressive symptoms.

Timeline: study set up, community engagement, pathway mapping: months 1-4 continuing alongside feasibility trial: months 5-17; full-scale RCT: months 19-42; analysis, final report, dissemination: months 43-48.

Anticipated impact & dissemination: The involvement of policy leaders at both sites are anticipated to support impact and sustainability alongside an intensive focus on training of practitioners and researchers as well as a consistent focus on community engagement.

The study will complement the existing evidence base for IPT in LMICs and provide an additional application with supporting research and implementation toolkit for both HI and LMICs.