A University of Liverpool study conducted in rural Pakistan in partnership with the Human Development Research Foundation and the Health Services Academy 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). This research, funded by the National Institute for Health and Care Research (NIHR), will help to address this global priority.
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% and 90% in these settings.
In response to this urgent need, University researchers developed an innovative 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, now published in Nature Medicine, show this novel intervention to be as effective as standard cognitive behaviour 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, Professor of Child Psychiatry and Global Mental Health at the University of Liverpool 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.
Importantly, 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.
This research was funded by the National Institute for Health and Care Research (NIHR), using international development funding from the UK Government to support Global Health Research.
The paper, ‘Technology-assisted cognitive-behavioural therapy for perinatal depression delivered by lived-experience peers: a cluster-randomized noninferiority trial’ is published in Nature Medicine: https://www.nature.com/articles/s41591-025-03655-1
