Stakeholder perspectives on antenatal depression and the potential for psychological intervention in rural Ethiopia: a qualitative study

Abstract

Background: Psychological interventions for antenatal depression are an integral part of evidence-based care but need to be contextualised for respective sociocultural settings. In this study, we aimed to understand women and healthcare workers' (HCWs) perspectives of antenatal depression, their treatment preferences and potential acceptability and feasibility of psychological interventions in the rural Ethiopian context. Methods: In-depth interviews were conducted with women who had previously scored above the locally validated cutoff (five or more) on the Patient Health Questionnaire during pregnancy (n = 8), primary healthcare workers (HCWs; nurses, midwives and health officers) (n = 8) and community-based health extension workers (n = 7). Translated interview transcripts were analysed using thematic analysis. Results: Women expressed their distress largely through somatic complaints, such as a headache and feeling weak. Facility and community-based HCWs suspected antenatal depression when women reported reduced appetite, sleep problems, difficulty bonding with the baby, or if they refused to breast-feed or were poorly engaged with antenatal care. Both women and HCWs perceived depression as a reaction ("thinking too much") to social adversities such as poverty, marital conflict, perinatal complications and losses. Depressive symptoms and social adversities were often attributed to spiritual causes. Women awaited God's will in isolation at home or talked to neighbours as coping mechanisms. HCWs' motivation to provide help, the availability of integrated primary mental health care and a culture among women of seeking advice were potential facilitators for acceptability of a psychological intervention. Fears of being seen publicly during pregnancy, domestic and farm workload and staff shortages in primary healthcare were potential barriers to acceptability of the intervention. Antenatal care providers such as midwives were considered best placed to deliver interventions, given their close interaction with women during pregnancy.

“We do not know how to screen and provide treatment”: a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia

“…Health administrators in this study discussed the introduction of the new mhGap action program, health professionals’ commitment, and simplicity of screening programs as enablers or facilitators for perinatal mental health service implementation. This is in line with a qualitative study that explored health professionals’ positive attitude towards the integration of mental health services as a facilitator for the acceptability of mental health services for perinatal women in Ethiopia [ 101 ]. The mhGap action program prioritises the integration of mental health services into primary care services, and maternal mental health has been considered as an essential component of this integration [ 51 ].…”

Acceptability and feasibility of peer-administered group interpersonal therapy for depression for people living with HIV/AIDS—a pilot study in Northwest Ethiopia

“…There are arguments among scholars on acceptable treatment approaches of IPT. Some scholars argue that a group-based approach is more acceptable and feasible than the individual-based approach [37,48], while others favour individual-based intervention [49]. The findings in this study indicated that, despite its implementation barriers, group-based IPT can be an acceptable and feasible approach for PLWHA in Ethiopia.…”

Brief problem-solving therapy for antenatal depressive symptoms in primary care in rural Ethiopia: protocol for a randomised, controlled feasibility trial

“…PST was considered a good fit with the problemoriented nature of presentations of psychological distress in antenatal care [39], the association of antenatal depression with maladaptive problem-solving and poor coping [40] and because of its simplicity, acceptability and effectiveness in a low literacy population [37,[41][42][43]. In our qualitative formative work [44], pregnant and postpartum women and community healthcare workers perceived depressive symptoms as responses to situational challenges which may thus be amenable to psychological interventions such as PST.…”