Mental health
Tech-assisted peer therapy effective for perinatal depression in lower income countries
A recent study has demonstrated the effectiveness of a novel, technology-assisted intervention for perinatal depression.
Perinatal mental health is one of the most pressing and under-addressed global health challenges, particularly in low- and middle-income countries (LMICs).
One in four women in LMICs suffers from perinatal depression, a condition linked to disability, maternal suicide, and long-term developmental harm to children.
Despite decades of concern voiced by child development experts and human rights advocates, access to effective treatment remains poor, with a treatment gap estimated between 75 per cent and 90 per cent in these settings.
University researchers developed a new intervention that combines peer-delivered cognitive behavioural therapy (CBT) with a co-produced digital app.
The intervention leverages the lived experience of local mothers from the community with no formal healthcare training, to deliver support.
This complements a culturally adapted, animated digital platform.
The Technology-assisted Peer-delivered Thinking Healthy Programme (THP-TAP) app automates key CBT elements using avatars and storytelling to ensure consistent quality and reliability, while peers focus on human interaction, delivering empathy, encouragement, and vital social support.
The results show this novel intervention to be as effective as standard cognitive behavioural therapy in treating perinatal depression, with women receiving the peer-delivered intervention experiencing significantly greater reductions in depressive symptoms at three months postnatal.
Atif Rahman is Professor of Child Psychiatry and Global Mental Health at the University of Liverpool.
Rahman said: “Our research shows that combining human empathy with technological innovation can deliver effective mental health care even in resource-constrained settings.
“This offers a fresh perspective on how we approach maternal mental health in LMICs.”
The model offers several advantages for scale-up. By using peer mothers as co-therapists, the intervention taps into a sustainable human resource.
The App ensures that essential therapeutic content is delivered accurately without constant specialist supervision.
Moreover, the intervention was found to be cost-effective and culturally acceptable, with high uptake and no evidence that stigma deterred participation.
The study is believed to be the first to demonstrate the robust effectiveness of a lived-experience peer and digital App working in tandem as co-therapists for perinatal depression in a low-resource setting.
Researchers believe the model holds promise for closing the quality gap that has long hindered task-sharing approaches in global mental health.
As LMICs continue to grapple with the severe shortage of mental health specialists, this innovation could offer a scalable, affordable, and community-driven solution to one of the most urgent threats to maternal and child health.
Inflammation may help flag depression in women with type 2 diabetes, new research reveals, but the link appears to vary by symptoms and by how depression is measured.
The findings suggest both the promise and the challenge of identifying biomarkers, measurable indicators in blood or other tests, for depression.
Women with type 2 diabetes are at higher risk of depression, which can accelerate diabetes complications, impair functioning and increase the risk of death. Research suggests inflammation may be a key link between the two conditions, as certain inflammatory biomarkers are frequently found in both.
Scientists have yet to identify an objective diagnostic biomarker for depression, such as something measured through blood work, a genetic test or a brain scan.
To diagnose and measure depression, mental health providers usually use questionnaires. Some add up the number of symptoms as a checklist, while others measure the severity of different symptoms.
Depression can also look very different from one person to the next, with symptoms spanning physical effects such as sleeping too much or too little, mood-related issues such as persistent sadness, and cognitive difficulties such as trouble concentrating.
Nicole Beaulieu Perez, assistant professor at NYU Rory Meyers College of Nursing and study author, said: “Depression is the most measured construct in all of science, but part of our problem is that we’re not defining depression the same, there may be different types, but we’re lumping them all together.
“The variability in depression symptoms complicates how we diagnose and treat it, particularly in the absence of validated biological markers.”
To better understand the connection between inflammation and different symptoms and measures of depression, researchers at NYU Rory Meyers College of Nursing studied 38 women with type 2 diabetes, many of whom were also living with HIV.
They analysed blood samples for 10 different inflammatory biomarkers, including CRP, IL-6, IL-4 and IL-8.
They also assessed participants for depression using PROMIS, an NIH-developed series of short questionnaires that includes measures of depression, anxiety, sleep and fatigue, as well as the CES-D, an older measure that adds up depression symptoms.
The researchers found that certain inflammatory biomarkers were linked to depression, but the associations varied depending on the measures and symptoms used.
Higher levels of depression and anxiety measured using PROMIS were associated with lower levels of IL-4.
They also found contradictory associations for CRP and IL-6. Both were positively correlated with depression when it was measured using CES-D and negatively correlated when it was measured using PROMIS.
Sleep disturbances measured using PROMIS were associated with IL-8.
Perez said: “It was interesting to see that, in some cases, the direction of these associations flipped entirely based on which measure of depression we were using.”
The findings, while preliminary because of the small number of people studied, suggest that the link between inflammatory biomarkers and depression may not be consistent across all measures or symptoms.
More research is needed to tease out the role of inflammation and whether subtypes of depression can be identified based on symptoms and objective biological markers.
Perez said: “We think there’s something going on with inflammation and depression, but if we look closely, we may find that’s true for some forms of depression but not others.”
She said she hoped that in future, pairing depression measures with biomarkers such as blood tests could provide more objectivity in diagnosing depression, which could help further destigmatise mental illness, as well as help clinicians catch it earlier and guide treatment.
Perez said: “Precision mental health has great potential.
“If we can identify a specific type of depression, for instance, one that appears to be driven by inflammation, this may inform which medications to try to target an underlying biological pathology, hopefully reducing the trial and error often needed to find an effective treatment for depression.
“By identifying specific inflammatory biomarkers linked to different dimensions of mental health, our findings suggest a path toward precision mental health that moves beyond one-size-fits-all approaches.”
A ‘miscarriage cradle’ is being introduced at three Scottish hospitals to help women experiencing miscarriage at home and in hospital.
The device was created by engineer Laura Corcoran after she lost her third baby.
Forced to devise her own way of collecting her baby’s remains, she came up with a solution to deal with the physical side so women could focus on their emotional loss.
Corcoran said: “My husband and I are both engineers, we went into problem-solving mode and we ended up using a kitchen sieve to collect baby over the toilet and then we used a Chinese takeout container to store baby in the fridge over the weekend, the hospital said I wasn’t allowed to bring them in out of hours and I miscarried on a Friday evening.”
Corcoran described the ordeal as ‘a really awful time’ and said she felt very vulnerable.
“It was completely undignified and it felt like I didn’t matter, my baby didn’t matter, there was nothing fit for purpose,” she added.
NHS Greater Glasgow and Clyde is the first UK health board to roll out its use.
The Royal Alexandra Hospital in Paisley, the Queen Elizabeth University Hospital and Princess Royal Maternity in Glasgow will offer the device to support women through miscarriage at home and in hospital.
It is believed to be the first time a group of hospitals in the UK has committed to embedding this type of support across multiple sites.
Laura’s invention came out of one of the darkest moments of her life, as she began to miscarry for the third time.
She was bleeding but was told there was no space for her in hospital and that she would have to manage the process at home.
Laura told BBC Scotland News: “Within the NHS, you have to miscarry three times before you are eligible for testing to try to find some answers.”
She said she asked the early pregnancy unit how to collect the baby and they said ‘just to manage’.
During her recovery, Laura became angry that she had not been given the tools she needed to navigate the process.
But then she realised it was not just her, there was nothing fit for purpose for any woman dealing with baby loss.
“Using my background as an engineer, I started cutting up cardboard, taping bits together, sketching ideas.
“When I had something, I went to the 3D printers and printed the first prototype,” Corcoran said.
After patient and clinical feedback, she arrived at the device now in use.
The device is semi-circular and sits under the toilet seat. In the centre is a removable sieve. It filters out what is not needed and keeps the baby.
It then goes into a watertight storage container which can be taken to hospital for testing, or for a burial or cremation.
Corcoran said: “It allows women not to have to think of the practical aspects, to think about the emotional aspects, the grief. It gives them some space and time.
“The possibility that you might not be able to collect the baby and get access to testing adds weight to the problem.
“To be able to collect the baby respectfully and without cross-contamination means women can get access to testing, find potential causes and then prevent them going through it again in their next pregnancy.”
Corcoran said an independent economic report for NHS England showed that 50 per cent uptake would save the NHS in Scotland £11.2m, free up 12,000 gynaecology surgery slots and save 10,000 emergency department visits.
Common menopause symptoms such as brain fog and memory problems do not appear to have a lasting impact on cognitive performance, a study suggests.
The study found that while brain fog is a real symptom commonly experienced by perimenopausal and post-menopausal women, there is no evidence that it has an ongoing impact on core cognitive abilities such as memory, attention, problem-solving and decision-making.
Menopause usually happens at about 51, and cognitive symptoms such as forgetfulness and brain fog, including memory lapses, mental slowing and attention difficulties, are reported by 40 to 80 per cent of women.
But findings have been mixed on whether those symptoms are directly linked to cognitive performance. Their biological basis also remains unclear.
Dr Laura Naysmith, postdoctoral research associate at King’s College London and the study’s first author, said: “Cognitive symptoms are very real and often quite a distressing aspect of the menopause.”
“While mental effort [may] need to increase to maintain cognitive function due to these symptoms, we hope it is reassuring to those experiencing symptoms that cognitive abilities can be preserved.”
“Our study found that core cognitive abilities are consistent between menopausal stages.”
Researchers analysed data from 14,234 women aged 45 to 55 in the REACT-Long Covid Study, a large community cohort in England.
Participants were divided into three groups by menopausal stage, pre-menopause, perimenopause and post-menopause, and reported cognitive symptoms before completing eight online tasks designed to test memory and reasoning.
The analysis found only minimal differences in overall cognitive performance across the three groups, with cognitive symptoms only weakly linked to performance in pre-menopause, perimenopause and post-menopause.
The researchers did find a very weak link between symptoms and performance, but further analysis suggested that cognitive symptoms were more closely associated with increased reporting of psychological symptoms, including anxiety and low mood, especially among perimenopausal and post-menopausal participants.
The team said no global cognitive dysfunction was seen, but stressed that the reported symptoms can still have a significant effect on quality of life.
They called for more precise measures of subjective cognitive difficulties in future research.
Adam Hampshire, the study’s senior author, said: “Next we will explore the basis of the observed elevation in cognitive symptoms in more detail, including whether specific aspects of cognitive performance, or particular groups of people with certain symptom profiles or HRT [hormone-replacement therapy] use, show clearer differences.”
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