Prom Maria C, Denduluri Amrutha, Philpotts Lisa L, Rondon Marta B, Borba Christina P C, Gelaye Bizu, Byatt Nancy
Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Front Psychiatry. 2022 Mar 14;13:859341. doi: 10.3389/fpsyt.2022.859341. eCollection 2022.
Women in low- and middle-income countries (LMICs) are disproportionally affected by perinatal depression and anxiety and lack access to mental health care. Integrating perinatal mental health care into routine maternal care is recommended to address gaps in access to mental health care in such under-resourced settings. Understanding the effectiveness of interventions that integrate perinatal mental health care into routine maternal care in LMICs is critical to inform ongoing intervention development, implementation, and scale-up. This systematic review aims to assess the effectiveness of interventions that integrate perinatal mental health care into routine maternal care to improve maternal mental health and infant health outcomes in LMICs.
In accordance with the PRISMA guidelines, an electronic database search was conducted seeking publications of controlled trials examining interventions that aimed to integrate perinatal mental health care into routine maternal care in LMICs. Abstracts and full text articles were independently reviewed by two authors for inclusion utilizing Covidence Review Software. Data was extracted and narrative synthesis was conducted.
Twenty studies met eligibility criteria from the initial search results of 2,382 unique citations. There was substantial heterogeneity between the study samples, intervention designs, and outcome assessments. Less than half of the studies focused on women with active depression or anxiety. Most studies (85%) implemented single intervention designs involving psychological, psychosocial, psychoeducational, or adjuvant emotion/stress management. There were few interventions utilizing multicomponent approaches, pharmacotherapy, or referral to mental health specialists. Outcome measures and assessment timing were highly variable. Eighteen studies demonstrated significantly greater improvement on depression and/or anxiety measures in the intervention group(s) as compared to control.
Integrated interventions can be effective in LMICs. The findings provide a critical understanding of current interventions design gaps. This includes the lack of comprehensive intervention designs that incorporate increasing intensity of treatment for more severe illness, pharmacotherapy, mental health specialist referrals, and non-mental health professional training and supervision. The findings also provide strategies to overcome design and implementation barriers in LMICs. Study findings provide a foundation for future evidence-based adaptation, implementation, and scale-up of interventions that integrate perinatal mental health care into routine maternal care in LMICs.
[https://www.crd.york.ac.uk/prospero/display_ record.php?ID=CRD42021259092], identifier [CRD42021259092].
低收入和中等收入国家（LMICs）的妇女受围产期抑郁和焦虑的影响尤为严重，且难以获得心理健康护理。建议将围产期心理健康护理纳入常规孕产妇护理，以弥补此类资源匮乏地区在心理健康护理可及性方面的差距。了解在低收入和中等收入国家将围产期心理健康护理纳入常规孕产妇护理的干预措施的有效性，对于指导正在进行的干预措施开发、实施和扩大规模至关重要。本系统评价旨在评估将围产期心理健康护理纳入常规孕产妇护理以改善低收入和中等收入国家孕产妇心理健康和婴儿健康结局的干预措施的有效性。
根据PRISMA指南，进行电子数据库检索，查找关于在低收入和中等收入国家旨在将围产期心理健康护理纳入常规孕产妇护理的干预措施的对照试验的出版物。两位作者使用Covidence Review软件独立审查摘要和全文文章以确定是否纳入。提取数据并进行叙述性综合分析。
在2382条独特引用的初始搜索结果中，有20项研究符合纳入标准。研究样本、干预设计和结局评估之间存在很大异质性。不到一半的研究关注患有活动性抑郁或焦虑的妇女。大多数研究（85%）采用单一干预设计，包括心理、心理社会、心理教育或辅助情绪/压力管理。很少有干预措施采用多成分方法、药物治疗或转诊至心理健康专家。结局测量和评估时间差异很大。18项研究表明，与对照组相比，干预组在抑郁和/或焦虑测量方面有显著更大的改善。
综合干预措施在低收入和中等收入国家可能有效。研究结果为当前干预设计差距提供了重要认识。这包括缺乏综合干预设计，即针对更严重疾病增加治疗强度、药物治疗、转诊至心理健康专家以及对非心理健康专业人员进行培训和监督。研究结果还提供了克服低收入和中等收入国家设计和实施障碍的策略。研究结果为未来基于证据的调整、实施和扩大将围产期心理健康护理纳入低收入和中等收入国家常规孕产妇护理的干预措施奠定了基础。
[https://www.crd.york.ac.uk/prospero/display_ record.php?ID=CRD42021259092]，标识符[CRD42021259092]。
