Responding to the challenge of Adolescent Perinatal Depression (RAPiD): protocol for a cluster randomized hybrid trial of psychosocial intervention in primary maternal care

Abstract

Background: Adolescent pregnancy is a pressing public health issue globally, and particularly in low and middleincome countries. Depression occurring in the perinatal period is common among women and more so among adolescent mothers. Effective treatments for the condition have been demonstrated in adults but the needs of adolescents are often unique, making such treatments unlikely to meet those needs. Method/study design: A hybrid effectiveness-implementation research study is described in which a cluster randomized trial design is used to explore the effectiveness as well as the utility in routine practice of an intervention package specifically designed for adolescents with perinatal depression. Consenting pregnant adolescents (aged less than 20 years) who are newly registered for antenatal care are enrolled into the trial if their fetal gestational age is less than 36 weeks and they score 12 or more on the Edinburgh Postnatal Depression Scale (EPDS). The intervention package consists of structured sessions of behavior activation, problem-solving treatment, and parenting skills training, and is delivered by primary maternal health care providers, complemented by support provided by a "neighborhood mother" identified by the adolescent. Mothers in the control arm receive care as usual. The trial is conducted in clinics where the maternal providers are trained to deliver routine depression care with the use of the WHO Mental Health Gap Action Programme, intervention guide. Assessments are undertaken by trained blinded assessors at baseline, at childbirth, and at 3 and 6 months postpartum. The primary outcome, assessed at 6 months, is the level of maternal depression (measured with the EPDS). The secondary outcome is parenting skills (assessed with the Home Observation Measurement of the Environment, Infant-Toddler version), while tertiary outcomes include measures of disability, quality of life, mother-child bonding, as well as infants' nutritional and growth indices. Discussion: This, to the best of our knowledge, will be the first fully-powered trial of an intervention package specifically designed to address the unique needs of adolescents with perinatal depression. Trial registration: ISRCTN16775958. Registered on 30 April 2019.

Good Practices in Perinatal Mental Health for Women during Wars and Migrations: A Narrative Synthesis from the COST Action Riseup-PPD in the Context of the War in Ukraine

“…Clear and effective health communication may help to reduce psychological distress and the feeling of isolation. Also, it will benefit refugees women by increasing their adherence to the new situation and promoting engagement with the display of more adaptive behaviors (Finset et al, 2020;Gureje et al, 2020;Hyman & Dussault, 2000;Mechakra-Tahiri et al, 2007). Although language can be a barrier, translating information into Ukrainian can be instrumental in bringing an important message to these women: that they are welcome.…”

Maternal Mental Health in Sub-Saharan Africa: A Systematic Review of Interventions for Common Perinatal Mental Health Disorders

“…At facility level, adolescents receive a series of problem-solving and behavioural activation sessions from trained practitioners. At community level, adolescents are paired with "neighbourhood mothers" to provide social support and additional parenting support(Gureje et al, 2020) given they may have been ostracised as a result of the pregnancy.The nal three studies (Chibanda et al, 2014; Gureje, 2019; Gureje et al, 2019) targeted women demonstrating symptoms of major depression delivered at health facility level through psychotherapeutic approaches. Adaptation of Interventions The rst adaptation, common across 4 of the studies, involved engagement with local stakeholders during intervention design (Gureje et al, 2019, 2020; San lippo et al, 2019; Singla et al, 2015).…”

“…Of the targeted interventions, two "risk" pro les were targeted; HIV positive women(Kaaya et al, 2013;Wagner et al, 2019) and adolescent mothers(Gureje et al, 2020). Of the 2 studies targeting HIV positive mothers, one targeted women demonstrating minor depressive symptoms(Wagner et al, 2019) whilst the second targeted all HIV positive pregnant women(Kaaya et al, 2013).…”

“…Both interventions were delivered at facility level, integrated with PMTCT services. The intervention targeting adolescent mothers demonstrating major depressive symptoms at health facility level was linked to community-based support mechanism called "neighbourhood mothers"(Gureje et al, 2020). At facility level, adolescents receive a series of problem-solving and behavioural activation sessions from trained practitioners.…”

“…One of the two parenting interventions (Singla et al, 2015) conducted qualitative formative research to identify parenting practices and goals through discussions around child care and maternal wellbeing, resulting in the inclusion of fathers as a key target of the intervention, as well as mothers and their children.A second common adaptation was the modi cation of the curriculum or the content of the intervention. Four of the studies explicitly discuss the adaptation of the content of the intervention to respond to cultural understandings of maternal mental health(Green et al, 2019;Gureje et al, 2019Gureje et al, , 2020Kaaya et al, 2013). The automated service piloted in Kenya was adapted to account for the cultural context, though details of the speci c adaptations are not provided in the study protocol(Green et al, 2019).…”