Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

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.

Health survey on anxiety, depression, and stress in Afghanistan: A large-scale cross-sectional survey study

“…This suggests that depression symptoms remained the same even after the war ended in Afghanistan. This nding is consistent with another study which found that psychological distress symptoms were prevalent among 75% of the national Afghan population [30], but much higher than a study among Afghan pregnant women which reported the prevalence of depression to be 60.9% [31], Compared to countries elsewhere in the world, a systematic review by Mahmud et al [32] examining depression during COVID-19 indicated that 30.5% of the global population exhibited symptoms of depression. These ndings suggest that in Afghanistan, the prevalence of depression exceeds that of the global average.…”

Prevalence of postpartum depression and its associated factors within a year after birth in Semey, Kazakhstan: A cross sectional study

“…The authors also highlight a high prevalence of PPD in the antenatal 36.4% and postpartum 34.3% periods among women. 29 Studies with similar high prevalence rates of PPD can also be seen in countries such as Pakistan (63%), 30 Afghanistan (60.93%), 31 Eswatini (47.4%) 32 and Croatia (45.03%) 6 and South Africa (39,93%). 33 However, the results of d 238 women (not including four women who were single or divorced/parents passed away) answered.…”

A Systematic Review of Interventions That Integrate Perinatal Mental Health Care Into Routine Maternal Care in Low- and Middle-Income Countries

“…Additionally, while the inclusion criteria selection of only controlled trials provides more robust data, it also means that it is not a full representation of all interventions that have integrated perinatal depression and anxiety care into routine maternal care in LMICs. During full text review, additional articles describing integrated care interventions were ultimately excluded due to lack of a comparison group or lack of outcome measures (84)(85)(86)(87)(88). However, the inclusion criteria selection for controlled trials over RCTs did allow for greater study inclusion and representation of existing interventions, as was intended.…”