14 - Psychotherapy for perinatal mental disorders in low- and middle-income countries

Abstract

Perinatal mental disorders are highly prevalent in low- and middle-income countries (LMIC) and contribute substantially to the burden of disease. They have wide-ranging impacts not only on women but also on their infants, and thus, women require particular psychotherapy attention during the perinatal period. Task sharing of mental health services has been used in the treatment for perinatal common mental disorders (PCMDs) in LMIC, with good effect sizes for psychological interventions and moderate effect sizes for health promotion interventions. Several considerations need to be taken into account when implementing psychotherapy for PCMDs in LMIC, including tailoring interventions to be relevant and acceptable to local contexts, choosing an appropriate and cost-effective therapeutic design, and using proved effective elements of therapy. Practical delivery considerations such as location, duration, and personnel are vital. We endorse a stepped-care model of mental health screening and service provision, integrated into public health services, using evidence-based psychotherapy for nonspecialist health-care workers with robust training and supervision.