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Lee-Carbon L, Nath S, Trevillion K, Byford S, Howard LM, Challacombe FL, Heslin M. Mental health service use among pregnant and early postpartum women. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2229-2240. [PMID: 35902425 PMCID: PMC9636080 DOI: 10.1007/s00127-022-02331-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To explore the proportion and characteristics of women with a mental disorder who have contact with mental health services during pregnancy and the postnatal period in a maternity service in London. METHODS Data from the WEll-being in pregNancy stuDY (WENDY), a prospective cohort study, were used. Women were recruited at their first appointment for antenatal care and assessed for mental disorders using the Structured Clinical Interview DSM-IV Axis I/II Disorders for Research. Clinical, sociodemographic and psychosocial characteristics were collected. Mental health service use data were collected for the period from study entry to 3 months postpartum. RESULTS Two hundred women met diagnostic criteria for a mental disorder. Fifty-five (34%) of these had at least one contact with mental health services. Moderate depression (OR 7.44, CI 2.03-27.28, p < 0.01), severe depression (OR 10.5, CI 2.68-41.12, p < 0.01), past psychiatric hospital admission (OR 3.76, CI 1.05-13.44, p < 0.05), symptoms of anxiety (OR 3.95, CI 1.86-8.37, p < 0.001) and perceived low levels of social support (OR 0.43, CI 0.18-1.01, p = 0.05) were associated with an increased likelihood of contact with mental health services in univariate analyses. However, only moderate (OR 5.92, CI 1.31-26.78, p = 0.02) and severe depression (OR 6.04, CI 1.08-33.72, p = 0.04) remained significant in the multivariate regressions analyses. CONCLUSION Only a third of women with a diagnosable mental disorder at their first antenatal appointment had any contact with mental health services during pregnancy or up to 3 months postpartum. Further research is warranted to elicit perinatal women's views about the potential barriers to accessing professional mental health care.
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Affiliation(s)
- Leonie Lee-Carbon
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Selina Nath
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,Population, Policy and Practice Research & Teaching Department, University College London, London, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Fiona L. Challacombe
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Brown S, Sprague C. Health care providers' perceptions of barriers to perinatal mental healthcare in South Africa. BMC Public Health 2021; 21:1905. [PMID: 34670531 PMCID: PMC8528557 DOI: 10.1186/s12889-021-11954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers' perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa. METHODS Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019-June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems' framework to organise the findings, depicted in a conceptual map. RESULTS Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors. CONCLUSION Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.
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Affiliation(s)
- Shelley Brown
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA USA
- Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA USA
- Center for Peace, Democracy and Development, Department of Conflict Resolution, Human Security and Global Governance, University of Massachusetts Boston, Boston, MA USA
| | - Courtenay Sprague
- Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA USA
- Center for Peace, Democracy and Development, Department of Conflict Resolution, Human Security and Global Governance, University of Massachusetts Boston, Boston, MA USA
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA USA
- Faculty of Health Sciences, University of the Witwatersrand (Wits), Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
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Rossouw L, Burger RP, Burger R. Testing an Incentive-Based and Community Health Worker Package Intervention to Improve Maternal Health and Nutrition Outcomes: A Pilot Randomized Controlled Trial. Matern Child Health J 2021; 25:1913-1922. [PMID: 34618311 DOI: 10.1007/s10995-021-03229-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In order to address South Africa's maternal and infant mortality and morbidity rates, patient and community-level preventable factors need to be identified and addressed. However, there are few rigorously implemented and tested studies in low- and middle-income countries that evaluate the impact of community-level interventions on maternal and infant health outcomes. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on maternal depressive symptoms, maternal nutrition and intention to exclusively breastfeed. METHOD The intervention was tested using a pilot randomised controlled trial consisting of 72 (39 treatment and 33 control) adult women, implemented in a low-income, peri-urban area in Cape Town, South Africa. Data was collected using a baseline questionnaire conducted shortly after recruitment, and an end line questionnaire conducted a week after giving birth. RESULTS The intervention resulted in a 0.928-point drop in the maternal depressive symptom scale (which ranges from 1 to 8). We find no evidence that the intervention has either a sizeable or precisely estimated impact on maternal nutrition, measured using middle-upper arm circumference. While the intervention has almost no effect on the infant feeding intention of women who own refrigerators, it has a very large positive effect of 3.349-points (on a scale ranging from 1 to 8) for women without refrigerators. CONCLUSION A package intervention consisting of psycho-social support, additional tailored health information, and an incentive to utilise public antenatal care services has the potential to increase exclusive breastfeeding intention and reduce maternal depressive symptoms among the economically vulnerable.
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Affiliation(s)
- Laura Rossouw
- School of Economics and Finance, University of the Witwatersrand, 1 Jan Smuts Ave, Johannesburg, South Africa.
| | - Rulof Petrus Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Abstract
Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.
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Affiliation(s)
- Nancy Byatt
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
| | - Wanlu Xu
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA
| | - Leonard L Levin
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,c Department of Pediatrics , Francis A. Countway Library of Medicine, Harvard Medical School , Boston , MA , USA
| | - Tiffany A Moore Simas
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
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Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, Carvalho SM, Levin LL, Biebel K, Byatt N. A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings. Clin Obstet Gynecol 2018; 61:573-590. [PMID: 29553986 PMCID: PMC6059986 DOI: 10.1097/grf.0000000000000360] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research. Critical to its real-world success will be consideration for practice workflow and logistics, and sustainability through novel reimbursement mechanisms.
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Affiliation(s)
- Tiffany A. Moore Simas
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
- Department of Pediatrics
| | - Michael P. Flynn
- University of Massachusetts Medical School, Worcester, MA
- Department of Obstetrics and Gynecology
| | | | | | - Leonard L. Levin
- University of Massachusetts Medical School, Worcester, MA
- Francis A. Countway Library of Medicine, Harvard Medical School, Boston, MA
- Department of Family and Community Medicine
| | - Kathleen Biebel
- University of Massachusetts Medical School, Worcester, MA
- Department of Psychiatry
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA
- UMass Memorial Health Care, Worcester, MA
- Department of Obstetrics and Gynecology
- Department of Psychiatry
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Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study. BMC Womens Health 2018; 18:119. [PMID: 29973182 PMCID: PMC6030741 DOI: 10.1186/s12905-018-0612-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/22/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence. METHODS We recruited adult women attending antenatal services at a primary-level maternity facility. Demographic, socioeconomic and psychosocial data were collected by questionnaire. The Expanded Mini- International Neuropsychiatric Interview (MINI) Version 5.0.0 was used to assess mental health status and the Revised Conflict Tactic Scale (CTS2) used to assess IPV in the six months prior to the study. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Descriptive, bivariate and logistic regression analyses were conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. From counselling case notes, a thematic content analysis was conducted to describe contextual factors pertaining to forms of domestic violence (DV). RESULTS The prevalence of IPV was 15% of a sample of 376 women. Women who were food insecure, unemployed, in stable but unmarried relationships, had experienced any form of past abuse and were not pleased about the current pregnancy were more likely to experience IPV. MINI-defined mental health problems and a history of mental illness were significantly associated with IPV. Qualitative analysis of 95 counselling case notes revealed that DV within the household was not limited to intimate partners and, DV in this context was often perceived as 'normal' behaviour by the participants. CONCLUSIONS This study contributes towards a greater understanding of the risk profile for IPV amongst pregnant women in low-income settings. Adversity, including food insecurity and mental ill-health are closely associated with IPV during the antenatal period. Advocates against violence against pregnant women are advised to consider that violence in the home may be perpetrated by non-intimate partners and may by enabled by a pervasive belief in the acceptability of the violence.
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Affiliation(s)
- Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Michael Onah
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
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Munodawafa M, Lund C, Schneider M. A process evaluation exploring the lay counsellor experience of delivering a task shared psycho-social intervention for perinatal depression in Khayelitsha, South Africa. BMC Psychiatry 2017; 17:236. [PMID: 28666425 PMCID: PMC5493861 DOI: 10.1186/s12888-017-1397-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Task sharing of psycho-social interventions for perinatal depression has been shown to be feasible, acceptable and effective in low and middle-income countries. This study conducted a process evaluation exploring the perceptions of counsellors who delivered a task shared psycho-social counselling intervention for perinatal depression in Khayelitsha, Cape Town together with independent fidelity ratings. METHODS Post intervention qualitative semi-structured interviews were conducted with six counsellors from the AFrica Focus on Intervention Research for Mental health (AFFIRM-SA) randomised controlled trial on their perceptions of delivering a task shared psycho-social intervention for perinatal depression. Themes were identified using the framework approach and were coded and analysed using Nvivo v11. These interviews were supplemented with fidelity ratings for each counsellor and supervision notes. RESULTS Facilitating factors in the delivery of the intervention included intervention related factors such as: the content of the intervention, ongoing training and supervision, using a counselling manual, conducting counselling sessions in the local language (isiXhosa) and fidelity to the manual; counsellor factors included counsellors' confidence and motivation to conduct the sessions; participant factors included older age, commitment and a desire to be helped. Barriers included contextual factors such as poverty, crime and lack of space to conduct counselling sessions and participant factors such as the nature of the participant's problem, young age, and avoidance of contact with counsellors. Fidelity ratings and dropout rates varied substantially between counsellors. CONCLUSION These findings show that a variety of intervention, counsellor, participant and contextual factors need to be considered in the delivery of task sharing counselling interventions. Careful attention needs to be paid to ongoing supervision and quality of care if lay counsellors are to deliver good quality task shared counselling interventions in under-resourced communities. TRIAL REGISTRATION Clinical Trials: NCT01977326 , registered on 24/10/2013; Pan African Clinical Trials Registry: PACTR201403000676264 , registered on 11/10/2013.
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Affiliation(s)
- Memory Munodawafa
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.
| | - Crick Lund
- 0000 0004 1937 1151grid.7836.aAlan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa ,0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, London, United Kingdom
| | - Marguerite Schneider
- 0000 0004 1937 1151grid.7836.aAlan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa
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Mumm R, Diaz-Monsalve S, Hänselmann E, Freund J, Wirsching M, Gärtner J, Gminski R, Vögtlin K, Körner M, Zirn L, Wittwer-Backofen U, Oni T, Kroeger A. Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data. Pathog Glob Health 2017; 111:7-22. [PMID: 28093045 DOI: 10.1080/20477724.2016.1275463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa. METHODS The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted. RESULTS Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care. CONCLUSION Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.
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Affiliation(s)
- Rebekka Mumm
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,b Faculty of Medicine, Biological Anthropology , University of Freiburg , Freiburg , Germany
| | - Sonia Diaz-Monsalve
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany
| | - Eva Hänselmann
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,c Faculty of Medicine, Clinic for Psychosomatic Medicine und Psychotherapy , University of Freiburg , Freiburg , Germany
| | - Johanna Freund
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,c Faculty of Medicine, Clinic for Psychosomatic Medicine und Psychotherapy , University of Freiburg , Freiburg , Germany
| | - Michael Wirsching
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,c Faculty of Medicine, Clinic for Psychosomatic Medicine und Psychotherapy , University of Freiburg , Freiburg , Germany
| | - Jan Gärtner
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,d Faculty of Medicine, Clinic for Palliative Care , University of Freiburg , Freiburg , Germany
| | - Richard Gminski
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,e Faculty of Medicine, Institute of Environmental Medicine and Hospital Hygiene , University of Freiburg , Freiburg , Germany
| | - Katrin Vögtlin
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,e Faculty of Medicine, Institute of Environmental Medicine and Hospital Hygiene , University of Freiburg , Freiburg , Germany
| | - Mirjam Körner
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,f Faculty of Medicine, Medical Sociology and Psychology , University of Freiburg , Freiburg , Germany
| | - Lena Zirn
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,f Faculty of Medicine, Medical Sociology and Psychology , University of Freiburg , Freiburg , Germany
| | - Ursula Wittwer-Backofen
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,b Faculty of Medicine, Biological Anthropology , University of Freiburg , Freiburg , Germany
| | - Tolu Oni
- g Division of Public Health Medicine, School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Axel Kroeger
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany
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Brittain K, Mellins CA, Phillips T, Zerbe A, Abrams EJ, Myer L, Remien RH. Social Support, Stigma and Antenatal Depression Among HIV-Infected Pregnant Women in South Africa. AIDS Behav 2017; 21:274-282. [PMID: 27052843 DOI: 10.1007/s10461-016-1389-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression, HIV-related stigma and low levels of social support may be particularly prevalent and adversely affect health and treatment outcomes among HIV-infected pregnant women. We examined factors associated with social support and stigma among pregnant women initiating antiretroviral therapy in the Western Cape, South Africa; and explored associations with depressive symptoms (Edinburgh Postnatal Depression Scale; EPDS) in linear regression models. Among 623 participants, 11 and 19 % had elevated EPDS scores using thresholds described in the original development of the scale (scores ≥13 and ≥10, respectively). Social support and stigma were highly interrelated and were associated with depressive symptoms. Stigma was observed to moderate the association between social support and depression scores; when levels of stigma were high, no association between social support and depression scores was observed. Elevated depression scores are prevalent in this setting, and interventions to reduce stigma and to address risk factors for depressive symptoms are needed.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Elaine J Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
- College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Azale T, Fekadu A, Hanlon C. Treatment gap and help-seeking for postpartum depression in a rural African setting. BMC Psychiatry 2016; 16:196. [PMID: 27287387 PMCID: PMC4901434 DOI: 10.1186/s12888-016-0892-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/27/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) affects more than one in ten women and is associated with adverse consequences for mother, child and family. Integrating mental health care into maternal health care platforms is proposed as a means of improving access to effective care and reducing the 'treatment gap' in low- and middle-income countries. This study aimed to determine the proportion of women with PPD who sought help form a health facility and the associated factors. METHODS A community based, cross-sectional survey was conducted in southern Ethiopia. A total of 3147 women who were between one and 12 months postpartum were screened for depressive symptoms in their home using a culturally validated version of the Patient Health Questionnaire (PHQ-9). Women scoring five or more (indicating potential depressive disorder) (n = 385) were interviewed regarding help-seeking behavior. Multiple logistic regression was used to identify factors associated independently with help-seeking from health services. RESULTS Only 4.2 % of women (n = 16) with high PPD symptoms had obtained mental health care and only 12.7 % of women (n = 49) had been in contact with any health service since the onset of their symptoms. In the multivariable analysis, urban residence, adjusted odds ratio (aOR): 4.39 (95 % confidence interval (CI) 1.23, 15.68); strong social support, aOR: 2.44 (95 % CI 1.30, 4.56); perceived physical cause, aOR: 6.61 (95 % CI 1.76, 24.80); perceived higher severity aOR: 2.28 (95 % CI 1.41, 5.47); perceived need for treatment aOR: 1.46 (95 % CI 1.57, 18.99); PHQ score, aOR: 1.14 (95 % CI 1.04, 1.25); and disability, aOR: 1.06 (95 % CI 1.01, 1.15) were associated significantly with help-seeking from health services. More than half of the women with high levels of PPD symptoms (n = 231; 60.0 %) attributed their symptoms to a psychosocial cause and 269 (69.9 %) perceived a need for treatment. Equal proportions endorsed biomedical treatment and traditional or religious healing as the appropriate intervention. CONCLUSION In the absence of an accessible maternal mental health service the treatment gap was very high. There is a need to create public awareness about PPD, its causes and consequences, and the need for help seeking. However, symptom attributions and help-seeking preferences indicate potential acceptability of interventions located in maternal health care services within primary care.
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Affiliation(s)
- Telake Azale
- Department of Health Education and Behavioral Sciences, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia. .,Department of Psychiatry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia.
| | - Abebaw Fekadu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia ,Department of Psychological Medicine, Centre for Affective Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia ,King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
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11
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Bell SA, Lori J, Redman R, Seng J. Development of a brief screening tool for women's mental health assessment in refugee settings: A psychometric evaluation. Int J Nurs Stud 2015; 52:1202-8. [PMID: 25892280 DOI: 10.1016/j.ijnurstu.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 03/25/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The detection of common mental disorders in humanitarian crisis settings requires a screening tool that is feasible to use as well as sensitive and specific. The Self-Report Questionnaire, developed by the World Health Organization in 1994 to detect presence or absence of common mental health disorders, has frequently been used among conflict-affected and refugee populations. Our goal was to identify a highly predictive and reliable subset of items to serve as a screening tool that can be used in busy, over-crowded, and low-resource primary health care settings to identify women who need mental health attention. METHODS We analyzed the responses on a version of the Self-Report Questionnaire expanded to include two suicidality items from 810 displaced women living in refugee camps in Rwanda. Screening items were selected and evaluated for predictive ability using logistic regression in a cross-validation process, sensitivity and specificity using receiver operating characteristic curve analysis, and internal consistency analysis. RESULTS A five-item screening tool resulted. Those items are "Do you feel unhappy?", Do you feel easily nervous, tense, or worried?", "Have you lost interest in things?", "Do you have trouble thinking clearly?" and "Has the thought of ending your life been on your mind?". CONCLUSION The Self-Report Questionnaire-5 may be an important tool for identifying common mental disorders as well as suicide ideation and behaviors when assessing mental health among women in crisis situations. Further evaluation of this tool is warranted.
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Affiliation(s)
- Sue Anne Bell
- University of Michigan School of Nursing, United States.
| | - Jody Lori
- University of Michigan School of Nursing, United States
| | | | - Julia Seng
- University of Michigan School of Nursing, Department of Obstetrics and Gynecology and Institute for Research on Women and Gender, United States
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