Randomized Controlled Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 22, 2017; 7(2): 98-105
Published online Jun 22, 2017. doi: 10.5498/wjp.v7.i2.98
Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan
Nusrat Husain, Nasim Chaudhry, Christine Furber, Hina Fayyaz, Tayyeba Kiran, Farah Lunat, Raza Ur Rahman, Saira Farhan, Batool Fatima
Nusrat Husain, University of Manchester, Honorary Consultant Psychiatrist Lancashire Care NHS Trust, Manchester M13 9PL, United Kingdom
Nusrat Husain, Manchester Academy of Health Sciences Centre, Manchester M13 9NT, United Kingdom
Nasim Chaudhry, Greater Manchester West Mental Health Trust, University of Manchester, Manchester M25 3BL, United Kingdom
Nasim Chaudhry, Hina Fayyaz, Tayyeba Kiran, Batool Fatima, Pakistan Institute of Living and Learning, Karachi 75500, Pakistan
Christine Furber, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, United Kingdom
Farah Lunat, Lancashire Care NHS Foundation Trust, Preston PR5 6AW, United Kingdom
Raza Ur Rahman, Dow University of Health Sciences, Karachi 74200, Pakistan
Saira Farhan, United Medical and Dental College, Karachi 74900, Pakistan
Author contributions: Husain N, Chaudhry N, Furber C and Lunat F were involved in designing the study, ongoing supervision and feedback in the process of qualitative analysis, writing the manuscript and final approval of the manuscript; Fayyaz H, Kiran T and Fatima B were involved in delivering training to the participants, qualitative analysis and writing the manuscript; Rahman RU and Farhan S provided supervision during data collection.
Supported by Pakistan Institute of Living and Learning, Dow University of Health Sciences Pakistan and University of Manchester, United Kingdom.
Institutional review board statement: The study was reviewed and approved by the Institutionalized Review Board of Dow University of Health Sciences, Karachi, Pakistan.
Clinical trial registration statement: NCT01309516. The study is registered at https://clinicaltrials.gov/ct2/show/NCT01309516?term=NCT01309516&rank=1.
Informed consent statement: All the study participants provided informed written consent prior to their inclusion in the study.
Conflict-of-interest statement: None.
Data sharing statement: Informed consent for data sharing was not obtained but the presented data are anonymized and the risk of identification is minimum.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nusrat Husain, MBBS, MCPS (Psych), DPH, MPH, Dip (Psych), MD, Proffesor of Psychiatry, University of Manchester, Honorary Consultant Psychiatrist Lancashire Care NHS Trust, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom. nusrat.husain@manchester.ac.uk
Telephone: +44-16-13067921
Received: December 3, 2016
Peer-review started: December 5, 2016
First decision: April 17, 2017
Revised: May 16, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: June 22, 2017

To understand the experience of maternal depression, the factors implicated in accessing health, and the acceptability of the psychosocial intervention.


The participants were recruited from the paediatrics outpatient department of Civil Hospital Karachi, Pakistan. The study started in December 2009 and completed in December 2010. Women with maternal depression, aged 18-44 years with children aged 0-30 mo who had received nutritional supplements, and participated in the intervention programme [called Learning through Play (LTP) plus] were included in the study. Qualitative interviews were conducted with 8 participants before the intervention and 7 participants after the intervention. A semi structured topic guide was used to conduct the interviews.


Framework analysis procedures were used to analyse the qualitative data. Four themes emerged: (1) the women’s contextual environment: Interpersonal conflicts, lack of social support and financial issues being the major barriers in assessing healthcare; (2) women’s isolation and powerlessness within the environment: Sense of loneliness was identified as a restricting factor to access healthcare; (3) the impact of the intervention (LTP-Plus): Women felt “listened to” and seemed empowered; and (4) empowered transformed women within the same contextual environment: The facilitator provided a “gardening role” in nurturing the women resulting in a positive transformation within the same environment. The women’s homes seemed to be more happy homes and there was a positive change in their behaviour towards their children.


Findings informed the further development and testing of culturally-appropriate psychosocial intervention (LTP+) for addressing maternal depression.

Keywords: Low income Country, Thinking Healthy Program, Learning through play, Maternal depression, Framework analysis, Exploratory analysis

Core tip: To our knowledge this is the first qualitative study from Pakistan exploring the experiences of depressed mothers participating in a group psychosocial intervention trial. This was part of a randomized control trial testing the acceptability and feasibility of a parenting intervention Learning through Play (LTP)-Plus among depressed women in a low-income setting. The LTP+ intervention focused on two key objectives. First was to stimulate early child development through a pictorial calendar among children from birth to 3 years. Second was to change negative thoughts patterns of mothers through culturally adapted cognitive behavioural therapy intervention. The intervention was acceptable and the qualitative data informed the further development of the intervention.