Development of a brief psychological intervention for perinatal depression (BIND‐P)

Abstract

Background Lack of recognition in national programs, poor referral system, and non‐availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low‐ and middle‐income countries (LAMICs). To address this there is an urgent need to develop an integrative and non‐specialist‐based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker‐based stepped care model and brief psychological intervention for PND. Methods A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit. Results A consensus was reached to develop an ANM (Auxillary nurse midwife)‐based stepped‐care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND‐P) was developed, which includes the components of the low‐intensity intervention (eg, exercise, sleep hygiene). Conclusion The BIND‐P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.

COVID-19 Pandemic and Stepped Care Model for Perinatal Depression in Rural India: Lessons Learned and the Way Forward

“…10,34 In the presence of constraints like interruption of services, loss of support, and virtual connectivity, stepped care models could sustain the mental health services in the rural and remote regions. 21 Also, these models could be more helpful if HCWs receive regular training. To the best of our knowledge, this is the first report to discuss the challenges with stepped care models adopted for mental health.…”

“…Considering the poor availability and accessibility of perinatal mental health services (PMHS) in India, we had developed and implemented a stepped care model (BIND-P model) in the rural region of Maharashtra, India. 13,21 The model involves collaboration among auxiliary nurse midwives (ANMs) and psychiatric services to improve access to PMHS. It also attempts to address some barriers of implementation (e.g., stigma, inadequate or lack of training) through training of nurses and conducting awareness sessions among the general population.…”

“…ANMs provide screening, brief psychological intervention for mild to moderate depression [patient health questionnaire (PHQ-2 ≥ 3, PHQ-9: 5-19)], and referral services to the perinatal women. 21,22 More details about the model of care, steps, and interventions that formed the basis for the BIND-P model are published elsewhere. 21,22 How has the COVID-19 Pandemic Affect the BIND-P Model?…”

“…21,22 More details about the model of care, steps, and interventions that formed the basis for the BIND-P model are published elsewhere. 21,22 How has the COVID-19 Pandemic Affect the BIND-P Model?…”

“…The BIND-P intervention components include exercise, sleep hygiene, dietary recommendations, and monitoring sheets (published elsewhere). 21,22 These dietary recommendations are directed towards preventing common nutritional deficiencies (e.g., iron deficiency anemia, vitamin B12 deficiency). During the follow-up visits, the women were expected to submit the self-recorded dietary intake in the chart provided.…”