Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

Mark Tomlinson,Habibullah Ahmadzai,Mickey Chopra,Deepika Chaudhery,Sofía Rodríguez Gómez,Cécile Bizouerne,Thandi Van Heyningen

doi:10.1186/s13033-020-00407-1

Abstract

BackgroundThe disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery.MethodsThis exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme.ResultsOf the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention.ConclusionIn poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce.

Highlights

The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response
It is recommended that such programmes consider home-visiting components and be integrated into existing infant and child health programmes
The highest proportion of mental disorder lies in low- and middle-income countries (LMICs), where

Summary

Introduction

The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. The highest proportion (more than 70%) of mental disorder lies in low- and middle-income countries (LMICs), where. The prevalence rate of depression during this period for mothers in LMICs is substantially higher than the 10–13%, reported in HICs [7]. High rates of untreated maternal mental disorders coupled with adverse socioeconomic conditions contribute to poor maternal health, reduced maternal functioning, and compromised child health and development outcomes [8]. The low detection and treatment rate of perinatal mental disorders in LMICs may be mitigated by the integration of routine screening into primary care maternity and infant services

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