Abstract
BackgroundPerinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda.MethodsPregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14.ResultsA total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI − 6.79 to − 3.47, p < 0.001) and 7.13 (95%CI − 8.68 to − 5.59, p < 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by − 11.78 points (CI 17.64 to − 5.92, p < 0.001) at midline and − 22.92 points (CI 17.64 to − 5.92, p < 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4–76.6%) and 93.7% (95%CI 87.8–96.8%) of respondents at midline and endline, respectively.ConclusionAn evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.
Highlights
Perinatal depression is of substantial public health importance in low and middle income countries
In this study we aimed to evaluate the impact of a midwife-delivered intervention on depressive symptom severity and disability among pregnant women 6 months after initiation of treatment for perinatal depression in rural Uganda, as part of the Programme for Improving Mental Health Care (PRIME) Mental Health Care Plan (MHCP)
The participants lost to follow-up did not present any demographic or clinical differences from those who were assessed at 6 months
Summary
Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. Perinatal depression is the most common mental health complication in the perinatal period [2, 3], with an estimated prevalence of 11.9% [4]. This burden is projected to grow dramatically in the decade [5]. The prevalence of perinatal depression in Africa is even higher than global estimates. In Uganda, the prevalence of perinatal depression ranges between 5 and 10% in pregnant women, [7,8,9]. Between 6 and 40% of HIV and non-HIV perinatal populations are at risk for depression [7, 10, 11]
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