Women who participated in a stepped approach to routine mental health screening and referrals for pregnant women reported a reduction in postpartum depression, according to researchers.
Simone Honikman, MBChB, MPhil, and colleagues from the University of Cape Town launched the Perinatal Mental Health Project (PMHP), based at the Mowbray Maternity Hospital in the Western Cape province of South Africa. The PMHP is a stepped care intervention for maternal mental health integrated with antenatal care. The program also provides a training program for health care workers.
“Despite high levels of antenatal and postnatal depression, there is no routine screening or treatment of maternal mental disorders in primary care settings in South Africa,” the researchers wrote.
In a case study of the PMHP, 6,347 women were offered screening at their first antenatal visit by nurses and midwives during routine history taking. Participants in the PMHP were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) and a risk factor assessment tool, which was designed for the PMHP and uses a yes/no tick-form consisting of 11 risk factors for mental distress.
Participants who scored at least 13 on the EPDS or at least 3 on the risk factor assessment tool were referred for onsite counseling, which would coincide with their next antenatal visit. Free individual counseling was provided for up to 1 year postpartum. Counseling services were coordinated by a full-time clinical psychologist, who oversaw a counseling team that included a lay counselor, another psychologist and a psychiatrist who worked on a part-time basis and provided counseling sessions every 2 weeks.
A number of therapeutic modalities such as psycho-education, bereavement counseling, problem solving and interpersonal therapy were available. Alcohol and substance use was explored further in counseling, as well.
Every participant counseled received a routine 6-week postnatal follow-up phone call in which the participant was asked about her birthing experience, adjustment to life with the baby, the experience of counseling and whether further help or resources were needed.
A preliminary analysis of participants’ self-reported data reveals that at 6 to 10 weeks postpartum, 87.8% of counseled women reported an improvement in their presenting problem, 79.9% of mothers reported to be coping and 74.6% reported a positive mood at the time of the assessment. A total of 91.7% of participants rated the sessions as a positive experience, according to the researchers.
Between July 2008 and June 2011, 90% of the 6,347 participants were offered mental health screening. During that time, 95% of participants accepted screening. Of the 5,407 participants screened, 32% qualified for referral to a counselor and 62% of those who qualified agreed to be referred. Two percent of women were referred to a psychiatrist. A total of 1,981 counseling sessions were conducted.
In terms of transplanting the PMHP model to different locations, the researchers said various challenges to stepped care must be explored.
“In South Africa, the availability of resources and the quality of health care varies quite substantially in rural and urban areas,” they wrote. “As all of the current PMHP sites are situated in urban areas, there is a need for the PMHP to establish a rural site in order to evaluate the model in diverse settings where fewer resources and different challenges exist.”
Disclosure: The researchers report no relevant financial disclosures.