填补治疗缺口：为南非开普敦凯伊利沙镇的围产期抑郁症开发一种任务分担式咨询干预措施。
Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa.
作者信息
Nyatsanza Memory, Schneider Marguerite, Davies Thandi, Lund Crick
机构信息
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
出版信息
BMC Psychiatry. 2016 May 26;16:164. doi: 10.1186/s12888-016-0873-y.
BACKGROUND
Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town.
METHODS
Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa.
RESULTS
The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual.
CONCLUSION
The development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries.
背景
围产期抑郁症是一个重大的公共卫生问题，在南非低收入地区尤为突出，那里心理健康专业人员短缺。需要由非专业人员提供新的心理干预措施来填补治疗缺口。本文描述了在开普敦凯伊利沙为围产期抑郁症开发一种基于手册的任务分担咨询干预措施的过程。
方法
对26名参与者进行了定性半结构化访谈，包括凯伊利沙一家诊所的服务提供者和服务使用者，以探讨任务分担咨询干预措施的可行性、可接受性和内容。访谈进行了录音、翻译和转录。使用框架分析方法确定主题，并使用NVivo v10进行编码和分析。在半结构化访谈之后，与心理健康专家就基于证据的抑郁症心理干预措施举办了一次研讨会，并对南非社区卫生工作者的咨询手册进行了文献回顾。
结果
研究结果表明，在以下条件下，任务分担咨询干预措施对凯伊利沙的抑郁症女性是可接受且可行的：（1）受访者更喜欢女性咨询师，并认为应由社区中一位经验丰富、会说科萨语的咨询师每月至少提供一次基于诊所的个人咨询服务；（2）咨询干预措施的内容应包括关于抑郁症认知和行为影响的心理教育、如何应对人际问题以及经济压力源。基于这些条件、手册回顾和专家咨询，确定了咨询干预措施的关键组成部分为：心理教育、解决问题、健康思维和行为激活。这些都包含在最终的咨询手册中。
结论
围产期抑郁症任务分担咨询干预措施的开发应参考当地服务使用者和服务提供者的意见和需求。该研究说明了在低收入和中等收入国家的任务分担框架内，如何将这些意见纳入基于证据的心理干预措施的开发中。
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