Impact of SPRING, an Integrated Mother-Child Focused Psychosocial Home-visiting Intervention, on Postpartum Depression in Rural India: A Cluster Randomized Controlled Trial.

Abstract

Background: Post-partum depression (PPD) adversely affects maternal and child health, yet evidence for integrated mother-child interventions remains limited in low-resource settings. We evaluated the impact of SPRING (Sustainable Programme Incorporating Nutrition and Games), an integrated mother-child psychosocial home-visiting intervention, on PPD outcomes in rural India.

Method: A cluster-randomized controlled trial evaluated the intervention's impact across 120 villages (24 clusters). Mother-infant dyads were identified through house-to-house surveillance, with PPD measured at 12 months post-partum using the Patient Health Questionnaire-9 (PHQ-9). While the intervention aimed to improve child growth and development by indirectly addressing maternal mental health, this article reports specifically on PPD outcomes.

Results: Among 2007 mothers completing assessments, PPD prevalence was 13.1%, with no significant difference between arms (RR = 0.98, 95% CI: 0.69-1.39, p = .90). No effect of intervention was found on PPD (mean PHQ-9 score 1.8 [SD 2.68] in the intervention group and 1.9 [SD 2.79] in the control group; effect size -0.02; 95% CI: -0.11, 0.07; p = .68). Analyses were intention-to-treat.

Conclusions: The lack of measurable impact in our study highlights two key considerations. First, integrated mother-child psychosocial interventions may require more targeted strategies to address depressive symptoms and reduce PPD. Second, implementation challenges, such as coverage and uptake, likely influence effectiveness. Notably, at least one in eight mothers in our study experienced PPD at 12 months post-partum, aligning with other Indian studies. This persistent burden, alongside unmet mental health needs, emphasizes the urgency for future integrated mother-child interventions to include PPD-specific components and critically monitor implementation, especially in rural settings.