Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India.
Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India.
Asia Pac Psychiatry. 2021 Mar;13(1):e12436. doi: 10.1111/appy.12436. Epub 2020 Oct 24.
Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND.
A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit.
A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene).
The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.
在中低收入国家（LMICs），国家项目中缺乏对围产期抑郁症（PND）的认识、转诊系统不佳以及缺乏训练有素的人力资源，这些都是提供 PND 服务的重要障碍。为了解决这一问题，迫切需要开发一种综合的、非专科为基础的阶梯式护理模式。作为其在印度国家心理健康计划（NMHP）目标领域研究重点的一部分，印度医学研究理事会资助了一个关于四个地点 PND 结果的研究项目。在本文中，我们描述了基于初级保健工作者的阶梯式护理模式和针对 PND 的简要心理干预的开发。
对 PND 的各个方面进行了文献综述，以在 NMHP 下开发一种护理和干预模式。一个由国家和国际专家和利益相关者组成的小组使用共识方法和世界卫生组织实施工具包，审查了文献、意见、观点以及针对不同模式和干预措施的建议。
达成了共识，开发了一种基于辅助护士助产士（ANM）的阶梯式护理模式，其中包括 PND 的护理、培训和转诊服务的组成部分。此外，还开发了一种简要心理干预（BIND-P），其中包括低强度干预（如运动、睡眠卫生）的组成部分。
BIND-P 模式和干预措施提供了一种实用的方法，可以促进对患有 PND 的女性进行有效的识别、治疗和支持。我们目前正在印度的四个研究地点评估这种模式，这可能有助于早期发现和提供适当的、综合的 PND 护理。
