无声的负担：中低收入国家常见围产期精神障碍的全景分析。

The silent burden: a landscape analysis of common perinatal mental disorders in low- and middle-income countries.

机构信息

MOMENTUM Country and Global Leadership, Washington, DC, USA.

出版信息

BMC Pregnancy Childbirth. 2022 Apr 20;22(1):342. doi: 10.1186/s12884-022-04589-z.

DOI:10.1186/s12884-022-04589-z

PMID:35443652

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9019797/

Abstract

BACKGROUND

Mental health has long fallen behind physical health in attention, funding, and action-especially in low- and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs.

METHODS

The landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scopus. Titles and abstracts were reviewed before a multidisciplinary team conducted data extraction and analysis on relevant articles. Second, 44 key informant interviews and two focus group discussions were conducted with mental health, MNCAH, humanitarian, nutrition, gender-based violence (GBV), advocacy, and implementation research experts. Finally, reviewers completed a document analysis of relevant mental health policies from 19 countries.

RESULTS

The LA identified risk factors for CPMDs, maternal mental health interventions and implementation strategies, and remaining knowledge gaps. Risk factors included social determinants, such as economic or gender inequality, and individual experiences, such as stillbirth. Core components identified in successful perinatal mental health (PMH) interventions at community level included stepped care, detailed context assessments, task-sharing models, and talk therapy; at health facility level, they included pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with GBV services. Yet, significant gaps remain in understanding how to address CPMDs.

CONCLUSION

These findings illuminate an urgent need to provide CPMD prevention and care to women in LMICs. The time is long overdue to take perinatal mental health seriously. Efforts should strive to generate better evidence while implementing successful approaches to help millions of women "suffering in silence."

摘要

背景

精神健康在关注、资金和行动方面长期落后于身体健康，尤其是在中低收入国家（LMICs）。尽管人们越来越意识到常见围产期精神障碍（CPMDs）会对代际产生影响，但它却明显缺席于全球生殖、孕产妇、新生儿、儿童和青少年健康（MNCAH）规划。然而，全民健康覆盖（UHC）运动和 COVID-19 将精神健康问题推到了前沿，MNCAH 社区正在努力了解如何大规模为女性提供有效、可持续的护理。为了解决这一问题，MOMENTUM 国家和全球领导力（MCGL）于 2020 年 12 月委托进行了一项景观分析，以评估 CPMD 的现状，并确定在 LMICs 中为解决负担所做的工作。

方法

景观分析（LA）采用了多层次的方法。首先，审查员选择了一种范围综述方法，在 PubMed、Google Scholar、PsychInfo 和 Scopus 中搜索文献。在多学科团队对相关文章进行数据提取和分析之前，先对标题和摘要进行了审查。其次，与精神健康、MNCAH、人道主义、营养、基于性别的暴力（GBV）、宣传和实施研究专家进行了 44 次重点信息访谈和两次焦点小组讨论。最后，审查员对 19 个国家的相关精神健康政策进行了文件分析。

结果

LA 确定了 CPMD 的风险因素、孕产妇精神健康干预措施和实施策略，以及仍然存在的知识差距。风险因素包括社会决定因素，如经济或性别不平等，以及个人经历，如死产。在社区层面成功开展围产期精神健康（PMH）干预措施的核心组成部分包括阶梯式护理、详细的背景评估、任务分担模式和谈话疗法；在卫生机构层面，包括对精神健康的岗前培训、经过培训和监督的提供者、转诊和评估流程、提供者的精神健康支持、提供尊重的护理以及与基于性别的暴力服务的联系。然而，在如何解决 CPMD 方面，仍然存在很大的差距。