Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria

This study identified predisposing, enabling, and hindering factors to health services utilization by adolescent mothers. Approximately 95% of all births to girls under age 18 occur in low- and middle -income countries (LMICs), where supporting infrastructure for healthcare is limited. Depression is a common and severe disorder among low-income adolescent mothers, where treatment often includes stigmatizing attitudes towards adolescent sexuality by healthcare providers. The study recognizes that it is difficult for someone young to enforce anything at home because they are not autonomous

Responding to the challenge of adolescent perinatal depression (RAPiD) : protocol for a cluster randomized hybrid trial of psychosocial intervention in primary maternal care

The project, “Responding to the challenge of adolescent perinatal depression (RAPiD)” is designed to address the need for interventions, as well as demonstrate effectiveness of interventions, for depressive disorders among adolescent mothers. The article provides a detailed proposal outline including background information and methodology of the RAPiD programme development and objectives, including conducting a comprehensive process evaluation to assess the barriers and facilitators of scaling up the intervention. Few studies have examined the effectiveness of interventions delivered to adolescents with perinatal depression. The World Health Organization estimates that up to 11% of all births worldwide are to girls aged between 15 and 19 years

High- versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial)

Background: Contextually appropriate interventions delivered by primary maternal care providers might be effective in reducing the treatment gap for perinatal depression.Aim: To compare a high intensity psychological intervention with a low intensity enhanced usual care in the treatment of perinatal depression.Methods: This cluster randomized clinical trial was conducted in Ibadan, Nigeria between June 18, 2013 and December 11, 2015. Twenty-nine maternal care clinics were randomized to either high intensity (HIT, n=15) or low intensity (LIT, n=14) treatment. Pregnant women, registering for antenatal care, assessed to have DSM-IV major depression, received either enhanced usual care delivered by providers using the WHO Mental Health Gap Action Programme – Intervention Guide (LIT arm) or 8 weekly structured problem solving prenatal sessions delivered within a stepped care model (HIT arm). Primary outcome was recovery from depression 6 months postpartum (score < 6 on the Edinburgh Postnatal Depression Scale, (EPDS). Results: There were 686 participants, 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed recovery rates of 70% in the HIT arm and 66% in the LIT arm: adjusted risk difference 4% (95%CI: -4·1%, 12·0%), adjusted odds ratio 1·12 (95%CI: 0·73, 1·72). HIT was more effective among women with higher baseline EPDS scores (adjusted interaction OR 2·29, 95%CI 1·01, 5·20).Conclusions: Except among more severely depressed perinatal women, we found no strong evidence to recommend high intensity in preference to low intensity psychological intervention in routine primary maternal care

A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria

Background Depression is common in primary care and is often unrecognized and untreated. Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers (PHCWs) in sub-Saharan Africa. We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care. Methods Six primary health care centers (PHCC) in two Local Government Areas of Oyo State, South West Nigeria were randomized into 3 intervention and 3 control clinics. Three PHCWs were selected for training from each of the participating clinics. The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation, activity scheduling, problem solving treatment and medication for severe depression. Providers from the control clinics delivered care as usual, enhanced by a refresher training on depression diagnosis and management. Outcome measures Patient’s Health Questionnaire (PHQ-9), WHO quality of Life instrument (WHOQOL-Bref) and the WHO disability assessment schedule (WHODAS) were administered in the participants’ home at baseline, 3 and 6 months. Results About 98% of the consecutive attendees to the clinics agreed to have the screening interview. Of those screened, 284 (22.7%) were positive (PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study: 165 from intervention and 69 from control clinics. The rates of eligible and consenting participants were similar in the control and intervention arms. In all 85.9% (92.8% in intervention and 83% in control) of the participants were successfully administered outcome assessments at 6 months. The PHCWs had little difficulty in delivering the intervention package. At 6 months follow up, depression symptoms had improved in 73.0% from the intervention arm compared to 51.6% control. Compared to the mean scores at baseline, there was improvement in the mean scores on all outcome measures in both arms at six months. Conclusion The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms

Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful

Quality of perinatal depression care in primary care setting in Nigeria

Abstract Background Even though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries. This study assessed the existing organization of service for maternal mental health, the actual care delivered for perinatal depression, as well as the quality of the care received by affected women presenting to primary care clinics in Ibadan, Nigeria. Methods The Assessment of Chronic Illness Care (ACIC) tool was administered to the staff in 23 primary maternal care clinics and key informant interviews were conducted with 20 facility managers to explore organizational and administrative features relevant to the delivery of maternal mental health care in the facilities. Detection rate of perinatal depression by maternal care providers was assessed by determining the proportion of depressed antenatal women identified by the providers. The women were then followed up from the antenatal period up until 6 months after childbirth to track their experience with care received. Results All the facilities had ACIC domain scores indicating poor capacity to offer quality chronic care. Emerging themes from the interviews included severe manpower shortage and absence of administrative and clinical support for manpower training and care provision. Only 31 of the 218 depressed women had been identified by the maternal care providers as having a psychological problem throughout the follow-up period. In spite of the objective evidence of inadequate care, most of the perinatal women rated the service provided in the facilities as being of good quality (96%) and reported being satisfied with the care received (98%). Conclusion There are major inadequacies in the organisational and administrative profile of these primary maternal care facilities that militate against the provision of quality chronic care. These inadequacies translate to a large treatment gap for women with perinatal depression. Lack of awareness by service users of what constitutes good quality care, indicative of low service expectation, may hamper user-driven demand for quality improvement