Identifying and treating maternal mental health difficulties in Afghanistan : a feasibility study
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: 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. This study
evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as
part of routine service delivery.
Methods: This 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.
Results: Of 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.
Conclusion: In 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.
Description
CITATION: Tomlinson, M. 2020. Identifying and treating maternal mental health difficulties in Afghanistan : a feasibility study. International Journal of Mental Health Systems, 14:75, doi:10.1186/s13033-020-00407-1.
The original publication is available at https://ijmhs.biomedcentral.com
The original publication is available at https://ijmhs.biomedcentral.com
Keywords
Mothers -- Mental health -- Afghanistan, Postpartum depression -- Incidence --Afghanistan, Mother and infant -- Psychological aspects -- Afghanistan
Citation
Tomlinson, M. 2020. Identifying and treating maternal mental health difficulties in Afghanistan : a feasibility study. International Journal of Mental Health Systems, 14:75, doi:10.1186/s13033-020-00407-1