Tomlinson Mark, Chaudhery Deepika, Ahmadzai Habibullah, Rodríguez Gómez Sofía, Rodríguez Gómez Cécile, van Heyningen Thandi, Chopra Mickey
Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa.
School of Nursing and Midwifery, Queens University, Belfast, UK.
Int J Ment Health Syst. 2020 Oct 27;14:75. doi: 10.1186/s13033-020-00407-1. eCollection 2020.
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.
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.
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.
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.
低收入和中等收入国家精神障碍负担过高，且资源极度匮乏，这就需要创新的干预和应对方法。本研究评估了在资源严重受限的环境中提供孕产妇心理健康服务作为常规服务一部分的可行性。
本探索性可行性研究在阿富汗的两个没有精神卫生专科工作人员的医疗机构开展。对过去12个月内分娩的妇女使用患者健康问卷-9（PHQ9）筛查抑郁症状，并邀请她们参加通过婴儿喂养计划提供的心理干预。
在筛查的215名妇女中，131名（60.9%）符合PHQ9转诊干预标准。以PHQ9临界值12分计算，产后抑郁筛查患病率为61%。此外，29%的妇女在PHQ9上登记有自杀倾向。该样本中的几个人口统计学和心理社会变量与抑郁症状相关，包括婴儿营养状况、焦虑症状、躯体和情绪症状、婚姻困难、亲密伴侣暴力、社会隔离、急性应激和创伤经历。在参加了全部六次干预的47名（65%）妇女中，所有妇女干预后PHQ9得分均显著降低。
在资源匮乏、产后抑郁患病率高的环境中，从基于专科的干预转向初级卫生保健层面的干预可能是提供孕产妇心理健康护理的可行途径。建议此类项目还应考虑家访部分，并纳入现有的婴幼儿健康项目。由非专科卫生工作者提供的标准化、循证心理干预在资源稀缺的情况下可改善结局。
