Health risk assessment of wildfire smoke exposure: a protocol for a systematic review and meta-analysis.

Pregnancy is a life stage marked by substantial physiological and psychological change and is associated with an increased risk of depression [, ]. Antenatal depression (AD) is a common psychiatric condition with severe implications for maternal and infant well-being, including associations with substance misuse, preeclampsia, postpartum depression, premature rupture of membranes, preterm birth, low birthweight, and lasting adverse child neurological, behavioral, and emotional development [–]. The estimated prevalence of AD is 24.2% in upper-middle-income and 18.1% in high-income countries []. There is a need for accessible, affordable and effective interventions to treat AD within the short window of pregnancy to mitigate adverse impacts on maternal and child health. In recent years, para-professional and peer-administered (peers being those in recovery from past perinatal depression) counselling interventions have increasingly been explored as cost-effective and accessible option for AD treatment, that aligns with the preferences of the perinatal population for non-pharmaceutical treatment [, , –]. Peer support interventions for depression have been found to significantly reduce depressive symptoms compared to usual care, with a moderate standardized mean difference (− 0.59, 95% CI: −0.98 to − 0.21;  = 0.002) [], supported by qualitative evidence of improved perceived support, and may be comparable to group cognitive behavioral therapy []. Both peer-support and more structured peer-administered counselling interventions offer significant benefits for patients with depression through sharing of common experiences, fostering empathy and support, and providing an environment for open discussion and connection, shown to promote active recovery [–]. However, the appropriateness of engaging peers as care-providers for AD has been the subject of recent academic debate [, ]. While some evidence suggests that those engaged in less formal peer-support report positive impacts on their well-being, [, ], other studies, particularly in low- and middle-income settings, report facilitator distress including stress and depressive symptoms, though reasons were not explored and may relate to insufficient training or supervision []. Overall, little is known about the nuanced experiences of the peers delivering counselling interventions, and whether they perceive any benefits or harms from the training and/or their counselling role. An improved understanding of peer-experiences of delivering para-professional counselling interventions for perinatal depression can enhance our understanding of ethical principles surrounding this promising avenue of treatment. Our qualitative study aimed to capture the firsthand experiences of non-professional volunteers with lived experience of perinatal depression in providing a remote behavioural activation (BA) counselling and peer support intervention for AD in Alberta, Canada.