The global burden of depression accounts for 2.5% of global DALYs, and in South Asia the
estimate is 13.3 % of DALYs per 100,000 populations. Mothers of children with Autism Spectrum
Disorder (ASD) have reported higher level of depression than mothers of children with other
developmental disorder and the prevalence of ASD is high in Asian countries. In Bangladesh
16% of adults suffer from depression and a recent study conducted in Bangladesh has
documented a high prevalence of depression among mothers of children with ASD (45%). Mothers
are the life time care givers of children with ASD, and a high burden of depression is likely
negatively impact on the ability of the mothers to provide care to children at home. Mental
health is not addressed in Bangladesh and there is scarcity of qualified providers.
The investigators propose to pilot the feasibility of a package intervention including
implementation of mental health care and home based training program for the mothers of
children with ASD integrated in the regular activities of the special schools that offer ASD
care in Dhaka city in Bangladesh.
The study will be conducted in 2 selected special schools over 15 months. In the first stage,
the investigators will set up the study in two schools and identify various stakeholders for
qualitative assessment of the barriers of implementing the intervention at the institutional
level, individual level, family level, provider level, policy maker level and at the level of
the state. Research staff will identify mothers 18 years of age or older who has a child with
ASD between 3 and 17 years of age enrolled in the school. Following consent, data collector
will obtain data and assess current major depressive episode (MDE) of the eligible mothers
following a standard diagnostic tool (SCID-I). All mothers diagnosed as having MDE will be
invited to participate in the intervention (intervention mothers) and the investigators will
assess the performances in children with ASD by applying ASD Diagnostic Check-list (ADCL).
In the second stage, investigators will implement interventions over 4-6 months, including
(a) implementing mental health care services at the selected schools targeting the
intervention mothers, and (b) organizing training sessions of the intervention mothers for
supporting child care at home for enhancing child performances. Every month a psychiatrist
will visit each school for providing necessary advice and treatment to the intervention
mothers or suggest referral to hospital care, if necessary.
One special educator will be deployed at each school who will organize structured training
sessions for educating the intervention mothers by using BCC materials developed and
validated by icddr,b in the local setting. The special educators will conduct multiple group
sessions including 5-8 mothers in each group for covering the 6 modules over 2 weeks time,
and follow up intervention mothers at home every month for conducting refresher's training,
documenting the need of additional training supports, and linking mother with an ASD expert
for helping mothers taking a decision.
In stage 3, investigators will conduct post intervention qualitative survey with various
stakeholders who would be involved with implementing the intervention and participated in the
baseline qualitative survey. End line assessment will be conducted of current major
depressive episode (MDE) among all mothers and assess the performance of the children of
intervention mothers in order to assess the impact of the training at home.
The primary outcome of the study is to assess the feasibility of institutionalizing the
combined intervention of mental health care supports and the home based training program of
the mothers who would be diagnosed as having major current major depressive episode. The
primary outcome will be assessed by obtaining the perspectives of various stakeholders. The
following parameters will be assessed for measuring feasibility of the proposed intervention.
Acceptability, Adaptability, Demands, Practicality, Implementation, Integration
The secondary outcomes will include estimating the impact of the combined interventions on
the prevalence rate of maternal depression (MDE), individual performances of children, and
cost of intervention. Adaptation of the proposed strategy, if feasible will help the mothers
of children with ASD become skilled workforces for filling in the gap of the special
educators in resource poor settings, and extension of these services to more children with