Adaptation and pilot testing of a couples-based intervention to prevent perinatal depression in rural india

The National Institute of Child Health and Human Development awarded the Regents of the University of California, San Francisco $249,000 on August 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to adapt and pilot test JODI (Joint Outreach for Depression and Gender Inequity), a couples-based intervention to prevent perinatal depression in rural India.

The award funds adaptation of JODI for the Maharashtra context through stakeholder consultations and theater testing, followed by a hybrid Type 1 implementation-effectiveness pilot randomized controlled trial with 100 couples at the VADU Health and Demographic Surveillance System in Pune District to assess feasibility, acceptability, and preliminary efficacy of JODI versus enhanced usual care. JODI integrates communal coping and systemic transactional models with a gender transformative framework, addressing structural and relational drivers of perinatal depression through dyadic coping skill-building and gender norm examination delivered by trained female lay counselors in weekly sessions. The intervention was developed during a prior K99 phase through global systematic review and formative qualitative research with perinatal couples in rural Rajasthan.

Work is performed in San Francisco, California, with period of performance from August 1, 2026, through July 31, 2029. King Edward Memorial Hospital Research Centre in Pune, India, is the sub-recipient, providing adaptation and pilot testing services including stakeholder consultations and theater testing at KEMRC in Pune.

Abstract

(see instructions): perinatal depression (PND) affects approximately 25% of women in india, with rates as high as 60% antenatally in preliminary data from the vadu health and demographic surveillance system (hdss) - a population-based surveillance platform covering 220,000 individuals across 22 villages in pune district, maharashtra. Untreated PND has cascading consequences for the entire family unit, including diminished mother-infant bonding, low birth weight, and long-term child developmental impairments. In india, where marital and family dynamics are primary determinants of women's mental health and health-seeking, couples-based approaches that engage husbands as active treatment partners are theoretically compelling yet entirely absent from south asia. This R00 will adapt and pilot test jodi (joint outreach for depression and gender inequity), the first couples-based PND treatment intervention designed for lay counselor delivery in an lmic, developed during the K99 phase through a global systematic review, formative qualitative research with perinatal couples in rural rajasthan, and series of stakeholder intervention development steps. Jodi integrates the communal coping model and bodenmann's systemic transactional model with a gender transformative framework to address the structural and relational drivers of PND through dyadic coping skill-building and gender norm examination across weekly sessions delivered by trained female lay counselors. In aim 1, jodi will be adapted for the maharashtra context through stakeholder consultations and theater testing in KEM hospital research centre (kemrc), pune. In aim 2, a hybrid type 1 implementation-effectiveness pilot RCT (n=100 couples) at the vadu hdss will assess feasibility, acceptability, and preliminary efficacy of jodi versus enhanced usual care, guided by proctor's framework. Findings will directly inform a future R01 full-scale multisite efficacy trial and, if effective, position jodi as a scalable, low-cost model for addressing PND across south asia and similar resource-limited settings.