Mohsin Shamaila, Atif Najia, Rabbani Waqas, Tariq Ahmaren, Khan Shahzad Ali, Tariq Mahjabeen, Sikander Siham
Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan.
Human Development Research Foundation, Islamabad, Pakistan.
Front Psychiatry. 2021 Apr 1;12:598857. doi: 10.3389/fpsyt.2021.598857. eCollection 2021.
Evidence indicates that mental health issues like depression, epilepsy, and substance misuse can be detected with reasonable accuracy in resource-poor settings. The Community Informant Detection Tool (CIDT) is one such approach used for detecting mental health problems, including depression. We adapted this community informant approach for detecting maternal depression in Pakistan. Adaptation of Community Informant Detection Tool for Maternal Depression (CIDT-MD) involved five steps. First, a scoping review of the literature was conducted to select an appropriate tool for adaptation. Second, in-depth interviews were conducted to explore the idioms of depression and distress, perceived causes, and the effects of maternal depression among currently depressed and recovered mothers ( = 11), mothers in law ( = 6), and Primary Care Providers (Primary Care Physicians and Lady Health Supervisors) ( = 6). Third, case vignettes and illustrations were created with input from a panel of mental health experts, incorporating the idioms of depression and distress used, causes, and effects for each symptom described. Fourth, to assess the comprehensibility of the illustrations and level of understanding, Focus Group Discussions ( = 4) were done with purposely selected community health workers (Lady Health Workers and Lay Peers, = 28) trained in delivering maternal depression intervention. The final step was reflection and inputs by a panel of mental health experts on all steps to finalize the content of the tool. Context-specific cultural adaptation in the presentation and format of CIDT-MD was conducted successfully. Lady Health Workers (LHW) and Lay Peers (LP) were found to be the most appropriate persons to use the tool and function as the informants. The adapted tool with all its vignettes and illustrations was found to be easily understandable, comprehensible, and culturally appropriate, meaningful, and contextually relevant by the community health workers and peers working in the relevant settings. They easily relate to and identify potentially depressed such women lining up with the tool. Lastly, the coding of the tool was found easy to follow as well. The Community Informant Detection Tool for Maternal Depression (CIDT-MD) is a culturally acceptable, easy to use, and comprehensible tool for detecting maternal depression in community settings of Pakistan. The community informants found the content and approach highly relevant to the local needs.
有证据表明，在资源匮乏的环境中，可以以合理的准确性检测出抑郁症、癫痫和药物滥用等心理健康问题。社区信息提供者检测工具（CIDT）就是用于检测包括抑郁症在内的心理健康问题的一种方法。我们对这种社区信息提供者方法进行了调整，以用于在巴基斯坦检测孕产妇抑郁症。孕产妇抑郁症社区信息提供者检测工具（CIDT-MD）的调整涉及五个步骤。首先，对文献进行范围审查，以选择合适的工具进行调整。其次，进行深入访谈，以探讨抑郁症和痛苦的表现形式、感知到的原因以及当前患有抑郁症和已康复的母亲（n = 11）、婆婆（n = 6）和初级保健提供者（初级保健医生和女性健康监督员）（n = 6）中孕产妇抑郁症的影响。第三，在心理健康专家小组的参与下创建病例 vignettes 和插图，纳入所使用的抑郁症和痛苦的表现形式、原因以及对所描述的每种症状的影响。第四，为了评估插图的可理解性和理解水平，与经过孕产妇抑郁症干预培训的特意挑选的社区卫生工作者（女性健康工作者和非专业同龄人，n = 28）进行了焦点小组讨论（n = 4）。最后一步是由心理健康专家小组对所有步骤进行反思并提供意见，以最终确定该工具的内容。成功地对 CIDT-MD 的呈现方式和格式进行了针对具体情况的文化调整。发现女性健康工作者（LHW）和非专业同龄人（LP）是使用该工具并充当信息提供者的最合适人选。事实证明，经过调整的工具及其所有 vignettes 和插图对于在相关环境中工作的社区卫生工作者和同龄人来说易于理解、文化上合适、有意义且与具体情况相关。他们很容易与该工具所描述的可能患有抑郁症的女性产生共鸣并识别出她们。最后，还发现该工具的编码也很容易遵循。孕产妇抑郁症社区信息提供者检测工具（CIDT-MD）是一种在巴基斯坦社区环境中检测孕产妇抑郁症的文化上可接受、易于使用且易于理解的工具。社区信息提供者发现其内容和方法与当地需求高度相关。
