A Problem-Solving Intervention for Women With Suicidal Ideation During Postnatal Period in Pakistan

Pakistan Institute of Living and Learning

Status: Enrolling

Conditions: Postnatal Depression

Treatments: Behavioral: Culturally Adapted Manual Assisted Therapy (CMAP-SI)

Study type: Interventional

Funder types: Other

Identifiers

NCT05852314

CMAP- PNSI

Details and patient eligibility

About

The aim of this study is to determine the feasibility and acceptability of culturally adapted CMAP for suicidal Ideation for women in postnatal period.

Objectives

1. To adapt existing CMAP Intervention for suicidal ideation (CMAP-SI) in postnatal period.
2. To investigate whether CMAP-SI is feasible and acceptable among women presenting suicidal Ideations in postnatal period; and
3. To test whether there is an indication for the effects of the CMAP in reducing suicidal thoughts among women in postnatal period.
4. To explore participants experiences with CMAP-SI Intervention.

Full description

Suicide is a major public health concern globally, affecting not only the individuals but also family members and society through increased resource costs and productivity loss. Although suicides and suicide attempts occur at a lower rate during pregnancy and the postpartum period than in general population, the prevalence of suicidal thoughts during these periods ranges from 5-14% worldwide and this may result in suicide attempts and completions. There is a growing evidence suggesting that suicidal thoughts and behaviour among women in postnatal period in Low-and Middle-Income Countries (LMICs) are comparable to postnatal women in high resource settings. For instance, in observational studies based on hospital samples of women in postnatal period, 11% women had suicidal behaviour (i.e., thoughts and attempts) in Pakistan, 14% in Ethiopia and 13.6% in Nepal. The causes of these high prevalence rates point to the underlying maternal health issues such as antenatal depression and common mental disorders such as anxiety and depression. Evidence based interventions exists in prevention, care and treatment of suicidal thoughts such as Cognitive Behavioural Therapy (CBT). To deliver a CBT based intervention in Pakistani context, Husain and colleagues tailored a treatment manual: "Life after Self-Harm" to the general population in Pakistan. This Culturally Adapted Manual Assisted Problem solving (CMAP) aims at suicide prevention by reducing the probability of self-harm. Pakistan being a low resource setting faces a huge challenge to provide health care to its population. Therefore, it is important to screen women in postnatal period for risk for suicidal thoughts and behaviour, as well as, the maternal health problems. It is equally important to deliver culturally sensitive interventions which are addressing the psycho-social context wherein suicidal behaviour occurs. Thus, the main aim of this study is to determine the feasibility and acceptability of culturally adapted CMAP for suicidal Ideation for women in postnatal period.

Enrollment: 90 estimated patients

Sex: Female

Ages: 16 to 44 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. 16 to 44-year-old mothers with children 0 - 30 months old
2. Residents of the trial site catchments area
3. Able to provide informed consent
4. Presenting with suicidal ideation as measured by the Beck Suicidal Ideation Scale (BSSI) (must score 1 or 2 on item 4 and 5)
5. Not requiring in-patient psychiatric treatment.

Exclusion criteria

We will exclude mothers with any physical or psychiatric condition severe enough to prevent study participation.

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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90 participants in 2 patient groups

Culturally Adapted Manual Assisted Therapy (CMAP-SI)

Experimental group

Description:

Participants in this arm will be offered the CMAP-SI intervention. The intervention will be delivered by trained researchers.

Treatment:

Behavioral: Culturally Adapted Manual Assisted Therapy (CMAP-SI)

Treatment as Usual (TAU)

No Intervention group

Description:

Local medical, psychiatric, and primary care services provide standard routine care in Pakistan. Participants will receive an initial assessment along with TAU as ascertained by their treating primary care physician (General Practitioner, GP). As part of the safety protocol, we will obtain the contact details of the participants GP. We will also obtain the details of any treatment received by each participant. Research psychologists delivering the interventions will not be involved with the participants allocated to the TAU.