{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:15:20Z","timestamp":1790738120737,"version":"4.1.0"},"reference-count":42,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Camb. prisms Glob. ment. health"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The ENHANCE non-inferiority trial that took place in a deprived setting in Pakistan demonstrated that a technology-assisted digital adaptation of the Technology Assisted Thinking Healthy Programme (THP-TAP) was no different than the face-to-face THP in improving symptoms of perinatal depression. The present study examines the mechanisms through which THP-TAP improved symptoms of perinatal depression (or not) compared to the face-to-face THP.<\/jats:p>\n                  <jats:p>We applied a counterfactual-based approach to mediation \u2013 particularly interventional effects \u2013 to decompose the total effect of the THP-TAP intervention on symptoms of perinatal depression into the following pre-specified indirect effects: number of sessions attended; behavioural activation; perceived social support; problem-solving and cognitive-restructuring skills; and peer empathy. Mediators were assessed at 3\u00a0months post-partum, and depressive symptoms were measured at 6\u00a0months using the Patient Health Questionnaire-9 (PHQ-9).<\/jats:p>\n                  <jats:p>Perceived social support in THP-TAP arm mediated an improvement in symptoms of perinatal depression compared to the standard face-to-face THP group (adjusted mean difference in PHQ-9 scores attributable to perceived social support in the technology-assisted digital adaptation of the THP group compared to the World Health Organisation THP group: \u22120.072, bias-corrected 95% confidence interval: \u22120.170, \u22120.018). There was no difference to support the indirect effects for all other mediators.<\/jats:p>\n                  <jats:p>Even in the absence of treatment superiority, our findings suggest that levels of perceived social support were an important feature of the THP-TAP intervention, which resulted in improved symptoms of perinatal depression. From a practical perspective, these findings highlight the importance of social connectedness as a mechanism of change, demonstrating that peer-delivered digital psychosocial interventions can successfully cultivate this relational component.<\/jats:p>","DOI":"10.1017\/gmh.2025.10109","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T07:54:53Z","timestamp":1765266893000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Comparing standard and technology-assisted peer-delivered CBT for perinatal depression: A causal mediation study"],"prefix":"10.1017","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3772-194X","authenticated-orcid":false,"given":"Ahmed","family":"Waqas","sequence":"first","affiliation":[{"name":"University of 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