Adaptation and pilot testing of a couples-based intervention to prevent perinatal depression in rural India - Project Summary Nearly one in four women in India experience perinatal depression, which occurs during pregnancy or the postpartum period. Preventing perinatal depression (PND) is important for the health of the mother and child as untreated PND is associated with long-lasting consequences such as an increased risk of suicide, impaired parenting, and adverse impacts on offspring. Dyadic or marital relationship-level risk factors such as low social support from the husband, inequitable couples’ relationship dynamics, and unequal decision-making are significant risk factors for perinatal depression. Couples-based interventions tested in high-income settings focused on mutable risk factors such as couples' relationship quality and social support have been shown to be effective in preventing perinatal depression. To date, depression interventions in low-income settings have primarily focused on treating pregnant women who are already experiencing depression, and limited trials have investigated preventive approaches. Further, there is a dearth of preventive trials addressing dyadic determinants by targeting couples. The goal of this K99/R00 Pathway to Independence Award application is to culturally adapt evidence-based intervention(s) as a couples-based intervention and conduct a pilot randomized controlled trial to assess feasibility, acceptability, and preliminary efficacy among primiparous (first-time pregnant) couples in rural central India. To achieve the mentored K99 phase and career transition to an independent investigator, I have assembled a multidisciplinary mentoring team with expertise in perinatal mental health, couples-based intervention development, implementation science and cross-cultural intervention adaptation, and dyadic skills. During the mentored phase (K99), I will pursue the following training and research objectives: (1) gain proficiency in dyadic data analysis with couples, (2) enhance my knowledge of perinatal mental health, and (3) acquire expertise in implementation science. The knowledge and skills gained in the mentored K99 phase will be instrumental in achieving the specific aims of the R00 phase, which are to: (1) Identify primiparous couples’ needs and preferences, and barriers and facilitators to engaging husbands, in a couples-based intervention to prevent PND; (2) Adapt evidence-based intervention(s) for couples to improve spousal support, shared decision-making, and couples’ relationship dynamics in the perinatal period to prevent PND; and (3) Assess the feasibility, acceptability, and preliminary efficacy of the adapted couples-based intervention through a pilot randomized controlled trial. I will use the results of the pilot to refine the intervention and develop an R01 proposal for a randomized controlled trial with a larger sample and longer follow-up, to assess the impact on long-term maternal and child health outcomes. The proposed training, and research plan in this K99/R00 application will prepare me for an independent research career focused on developing and adapting couples-based interventions to address dyadic determinants to improve maternal and newborn, and child health.
