Is there an optimal screening tool for identifying perinatal depression within clinical settings of sub-Saharan Africa?

Abstract: Depression is a leading cause of maternal morbidity and mortality worldwide and the most common complication of the perinatal period. Women in sub-Saharan Africa (SSA) are disproportionately impacted by perinatal depression. Maternal and child health (MCH) clinics are widely attended in SSA, offering a potential access point for depression screening. Yet, selection of optimal depression screening instruments for use within MCH clinics in SSA remains unclear. We synthesized evidence depicting relative strength of perinatal depression screening scales for use among African perinatal women within four evaluation domains: 1) diagnostic performance, 2) cultural adaptation, 3) feasibility and ease of implementation, 4) experience using the tool in SSA perinatal populations. The Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) had the most evidence among peripartum women in SSA, and a balance of feasibility, diagnostic performance metrics, and cultural adaptations. Other depressive screening instruments developed for general populations show strengths for application in African perinatal populations in at least one evaluation domain. Building health services capacity to integrate depression screening within routine MCH visits is an important next step to address perinatal depression in SSA

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

Perinatal Depression and Its Impact on Infant Outcomes and Maternal-Nurse SMS Communication in a Cohort of Kenyan Women

Abstract: Background Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity/mortality, and compared SMS communication patterns between women with and without perinatal depression. Methods This was a prospective longitudinal cohort of pregnant women seeking antenatal services at two public sector health clinics in Kenya. SMS messages were sent to participants with educational content related to their pregnancy and infant health and two-way SMS communication occurred with a nurse. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30-36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depressive symptoms, infant outcomes, and frequency of SMS messaging. Results Of the 572 women with complete follow-up information, 188 (32.9%) screened positive for elevated depressive symptoms (≥10 by EPDS scale) at some time point during pregnancy or postpartum. The strongest predictors of depressive symptoms included abuse during pregnancy, fewer years of schooling, and maternal unemployment. Antenatal depressive symptoms were associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depressive symptoms sent fewer SMS messages during the study period than their counterparts without depression. Conclusions Prevalence of elevated perinatal depressive symptoms was high in this cohort of Kenyan women. Our findings highlight the importance of screening perinatal women for experiences of abuse and symptoms of depression. Differences in messaging frequency between women with vs. without depressive symptoms presents a potential opportunity to provide more support for those perinatal depression

Delivering perinatal depression care in a rural obstetric setting: a mixed methods analysis of feasibility, acceptability and effectiveness.

Thesis (Master's)--University of Washington, 2017-06Introduction: Many obstetric and primary care settings implement universal screening for depression during pregnancy and postpartum, yet mental health follow up rates are low in rural settings. Depression treatment integrated into obstetric settings allows for timely, evidence-based treatment of women with depression. Digital encounters such as text messages can further address barriers to care in perinatal women. Methods: We conducted an open treatment trial of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Pregnant and postpartum women who screened positive for depression participated. They received Problem Solving Therapy (PST) with or without antidepressants. A care manager (CM) coordinated communication between patient, obstetrician and psychiatric consultant. In between sessions, CMs communicated with patients by two way text messaging. We measured change in the Patient Health Questionnaire 9 (PHQ -9) score; and used surveys and focus groups to measure patient and provider satisfaction. We analyzed focus groups and text messaging content using qualitative analysis software. Results: Recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) were comparable to clinical trials in similar urban populations. The intervention, including text messaging was well accepted by providers and patients. Conclusions: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible, acceptable and effective. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression and text messages are a useful adjunct to this care

Infertility and Perinatal Loss: When the Bough Breaks

Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy

Pregnant and Postpartum Women With Bipolar Disorder: Taking the Care to Where They Are

Up to 20% of women who screen positive for depression in the perinatal period in primary care and obstetric settings may have bipolar disorder, but little is known about best practices for this population. This column describes clinical programs that support identification and management of depression and bipolar disorder among women in non-mental health settings. The programs use diverse management strategies, including referral to specialty mental health, collaborative care, and consultation and care coordination. Most mental health programs based in primary care and obstetric settings are designed for depression treatment. Assessment and treatment strategies need to be refined to ensure that women with bipolar disorder receive appropriate care

Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study

Objectives Perinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in mental health symptoms and transmission risks associated with in-person appointments, many clinics transitioned to providing telepsychiatry care during the COVID-19 pandemic. This study sought to identify the facilitators and barriers to receiving perinatal telepsychiatry care from the perspective of patients, clinic staff and psychiatrists.Design Qualitative study based on analysis of in depth semistructured interviews.Setting The study was conducted in a virtual specialty mental health clinic in an academic setting.Participants Eight patients who had been scheduled for an appointment with the perinatal telepsychiatry clinic between 14 May 2021 and 1 August 2021, seven of whom had attended their scheduled appointment with the clinic and one of whom had not, and five staff members including psychiatrists, navigators and clinic managers, participated in in-depth interviews.Results Telepsychiatry was perceived by most as preferable to in-person care and easy to attend and navigate. Alternatively, technological difficulties, personal preference for in-person care and scheduling conflicts related to the perinatal period were identified as barriers by some. Participants identified communication between care staff and patients, online patient portals, and appointment reminders as important for facilitating appointment preparedness and attendance.Conclusions The findings from this study suggest that telepsychiatry services are perceived positively by patients and care staff and have the potential to improve access to mental healthcare for perinatal patients

Parenting and perinatal depression: meeting women’s needs

Introduction: Symptoms of depression during pregnancy and the postpartum period can negatively impact parenting. It is important to understand the parenting experiences of women with depression, and what parenting support they need. Methods: This is a mixed methods analysis of data (demographic data, depression outcomes, patient survey results, and transcripts of patient and care manager focus groups) from an open treatment trial of the feasibility of delivering perinatal depression treatment using collaborative care in a rural obstetric setting. Results: Patients who attended focus groups did not differ significantly from those who did not. Qualitative analysis of focus groups revealed the following themes: Maternal mood and parenting difficulties are interrelated; Access to depression treatment is complicated by expectations for the perinatal period and by factors related to parenting; Women want parenting support in the context of treatment for perinatal depression. Conclusion: Women receiving perinatal depression treatment experience unique parenting challenges and desire parenting support. Healthcare providers caring for these women should be mindful of their patients’ parenting needs. Future research should explore ways to integrate parenting interventions with depression treatments. Mother–infant interaction is a key determinant of optimal infant development and integrating parenting support with perinatal depression treatments can have significant public health impact