Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa.
Perinatal Mental Health Project, Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
Sci Rep. 2023 Aug 1;13(1):12457. doi: 10.1038/s41598-023-36150-z.
In South Africa, symptoms of common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period and linked to experiences of domestic violence. However, limited routine detection and treatment is available to pregnant women with these problems, even though evidence suggests that screening and treating CMDs during pregnancy improves the health and economic outcomes of mothers and their children, and has been suggested as a key approach to improving the health of perinatal women and children. We investigated facilitators and barriers of service-providers and service-users in detecting and treating pregnant women with symptoms of CMDs and experiences of domestic violence. This study was conducted in four midwife obstetric units (MOUs) in Cape Town, South Africa, and in the non-profit organisations providing community-based support in the communities surrounding the MOUs. Service-provider perspectives were informed by qualitative interviews with 37 healthcare workers providing care to pregnant women. Qualitative interviews with 38 pregnant women attending the same MOUs for their first antenatal care visit provided service-user perspectives. Facilitators identified included the availability of a mental health screening questionnaire and the perceived importance of detection and treatment by both service-providers and -users. Barriers contributing to the low detection rates included service-users concerns about the lack of confidentiality and feelings of shame related to experiences of domestic violence as well as service providers discomfort in dealing with mental health issues, their limited time available and heavy patient load. In addition, service-providers highlighted the lack of standardised referral pathways and the poor uptake of referrals by women with symptoms of depression and anxiety, or experiences of domestic violence. While the system-level barriers need to be addressed at a policy level, the patient- and provider-level barriers identified indicate the need to strengthen health systems by training antenatal care nurses to detect symptoms of CMDs and experiences of domestic violence in pregnant women, developing standardised referral pathways and training lay healthcare workers to provide treatment for mild symptoms of depression and anxiety.
在南非，围产期常见精神障碍（CMD）的症状（如抑郁和焦虑）非常普遍，与家庭暴力经历有关。然而，患有这些问题的孕妇可获得的常规检测和治疗手段有限，尽管有证据表明，在怀孕期间筛查和治疗 CMD 可以改善母亲及其子女的健康和经济结局，并且已经提出这是改善围产期妇女和儿童健康的关键方法。我们调查了服务提供者和服务使用者在检测和治疗患有 CMD 症状和经历家庭暴力的孕妇方面的促进因素和障碍。这项研究在南非开普敦的四个助产士产科单位（MOUs）以及为 MOUs 周边社区提供社区支持的非营利组织中进行。通过对为孕妇提供护理的 37 名医护人员进行定性访谈，了解了服务提供者的观点。对在同一 MOUs 首次接受产前护理就诊的 38 名孕妇进行了定性访谈，了解了服务使用者的观点。确定的促进因素包括心理健康筛查问卷的可用性，以及服务提供者和服务使用者都认为检测和治疗的重要性。导致低检测率的障碍包括服务使用者对缺乏保密性的担忧、与家庭暴力经历相关的羞耻感以及服务提供者在处理心理健康问题方面的不适、他们可用的时间有限以及患者人数众多。此外，服务提供者强调缺乏标准化转诊途径，以及患有抑郁和焦虑症状或经历过家庭暴力的妇女对转诊的接受度低。虽然需要在政策层面解决系统层面的障碍，但所确定的患者和提供者层面的障碍表明，需要通过培训产前护理护士来加强卫生系统，以检测孕妇的 CMD 症状和家庭暴力经历，制定标准化转诊途径，并培训非专业医疗保健工作者为轻度抑郁和焦虑症状提供治疗。
