Adolescent birth rate in Pakistan is amongst the highest in the world with 10% of women giving birth before the age of 18. There is a five-fold increase in prevalence rates of depression following marriage and pregnancy in women younger than 20 years of age compared to unmarried 18-year-olds, possibly related to a rapid role transition accompanied by several potentially difficult life events clustered closely together. These include marriage, moving in with the husband’s family, pregnancy, and childbirth. Currently, there is no intervention in low and middle-income countries (LMICs) that equips newly-wed couples with skills to negotiate these life transitions. We aimed to develop a scalable psychological intervention incorporating evidence-based cognitive behavioral and life skills strategies for newly-wed adolescent women, their husbands and families, living in very poor rural settings in Pakistan.