Abstract
BackgroundSymptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study.MethodsWe conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material.ResultsThe manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method.ConclusionInput from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.
Highlights
Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities
There is a high prevalence of Common Mental Disorders (CMDs) such as anxiety and depression amongst women in the perinatal period, in low- and middle-income countries (LMICs) [1,2,3,4]
A systematic review and meta-analysis of Perinatal Common Mental Disorders (PCMDs) in LMICs reported 19–25% prevalence of perinatal depression and 26–35% prevalence of symptoms of anxiety, compared to HICs where prevalence ranged between 7–15% and 14–20%, respectively [1, 3]
Summary
Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. In South Africa, a community-based cluster randomised controlled trial (RCT) conducted in two peri-urban settlements of Cape Town reported that 39% of pregnant women suffered from symptoms of depression [5], while a cross-sectional study of pregnant women in an urban area of Cape Town reported a 23% prevalence of any diagnosable anxiety disorders [6]. Risk factors such as poverty, an unintended pregnancy, violence, lack of support and a history of mental illness are considered consistent predictors of depression and anxiety, with multiple stressors increasing the risk [2, 6, 7]. Developing an effective, scalable, and culturally sensitive intervention to treat perinatal depression and anxiety, for diverse, low-resource communities in LMICs, is a public mental health priority
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