Abstract / Summary
Cognitive behavioural interventions (CBIs) delivered by nonspecialist providers (NSPs) offer a scalable strategy to address the global mental health workforce gap, enhancing access to evidence-based care for perinatal depression and anxiety. The objective of this systematic review will be to evaluate the effectiveness of CBIs delivered by NSPs in reducing perinatal depression and anxiety and to narratively synthesise evidence on their implementation processes and selected implementation outcomes, including acceptability, feasibility, fidelity, implementation cost, and sustainability. Eight electronic databases (PubMed, Web of Science, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, WanFang, and CNKI) will be systematically searched from their inception to April 8, 2025. Eligible studies will be randomised controlled trials (RCTs) evaluating CBIs delivered by NSPs for the prevention or treatment of perinatal depression and/or anxiety. The primary outcomes will be symptoms of perinatal depression and/or anxiety. Two reviewers will independently screen records, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Where clinical and methodological comparability permit, data will be synthesized using random-effects meta-analyses in Stata version 18.0. Subgroup analyses, sensitivity analyses, meta-regression, and assessments of publication bias will be conducted where sufficient data are available. Implementation processes and implementation outcomes will be summarised descriptively using frequencies and percentages across included trials. Against persistent shortages of specialist mental health professionals, task sharing may offer a scalable approach to improving access to perinatal mental health care. However, evidence on NSP-delivered CBIs remains fragmented across clinical effectiveness and implementation domains. By synthesising their immediate and longer-term effects on perinatal depression and anxiety alongside implementation processes and selected implementation outcomes reported within RCTs, this review will clarify both their clinical benefits and factors relevant to their integration into routine care. The findings will inform the design, evaluation, and scale-up of task-sharing models and identify priorities for future research and reporting.