Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study
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International Journal of Mental Health Systems Open Access
RESEARCH
Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study Mark Tomlinson1,2* , Deepika Chaudhery3, Habibullah Ahmadzai3, Sofía Rodríguez Gómez4, Cécile Rodríguez Gómez4, Thandi van Heyningen5 and Mickey Chopra6
Abstract Background: The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery. Methods: This exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme. Results: Of the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention. Conclusion: In poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce. Background Approximately 4.4% of the world’s population suffer from depression and prevalence is increasing [1]. The highest proportion (more than 70%) of mental disorder lies in low- and middle-income countries (LMICs), where *Correspondence: [email protected] 1 Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa Full list of author information is available at the end of the article
the treatment gap (the difference between the number of people who need care and those who receive care) for mental disorders is estimated to be between 76 and 85% [2]. Globally, 78% of deaths by suicide occur in LMICs [1]. In LMICs that have experienced conflict in the past two decades, a recent system
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