Antenatal depression in Sri Lanka: a qualitative study of public health midwives’ views and practices

Abstract

Background Almost all pregnant people in Sri Lanka receive antenatal care by public health midwives. While there is strong infrastructure in Sri Lanka for postpartum mental health care, the current practices within antenatal mental health care have not been externally evaluated. The purpose of this study is to investigate the current clinical guidelines and experiences of how public health midwives diagnose and treat antenatal depression. Methods We conducted in-depth interviews with 12 public health midwives from four antenatal clinics in the Bope Poddala division in Galle, Sri Lanka and reviewed and extracted information on antenatal depression from clinical guidelines. Data was collected in Sinhala and translated into English. We used applied thematic analysis and worked closely with our local team to ensure data trustworthiness. Results Midwives (n = 12) reported varying degrees of knowledge on antenatal depression and did not have standardized diagnosis patterns. However, they were very consistent in their clinical practices, following guidelines for referral and follow-up of case management, building strong rapport. In their practice, midwives continue to face challenges of lack of human resources and high stigma around mental illness. They suggested that that care could be improved with use of a standardized diagnostic tool, and easier access to specialist care. We found the clinical guideline on the diagnosis and treatment of antenatal depression is lacking key details on symptoms for appropriate diagnosis, but it clearly guides on how to navigate treatment. Conclusions Public health midwives are following the clinical guideline to refer pregnant women who need intervention for antenatal depression and follow-up for case management. However, there is a need for more specific and context-relevant guidelines, especially for diagnosis of antenatal depression. Formative research is needed to explore intervention strategies to improve antenatal depression management in Sri Lanka.

experience of midwife in delivering the midwifery care of mental illness of pregnant women and post-partum during the pandemic of COVID-19

“…Midwives can help with therapy by talking to a psychiatrist and monitoring pregnant women. The midwife is a major role in the follow-up of treatment, making home visits after the treatment begins to examine the mother in their care (Wyatt et al, 2022). Treatment for mothers diagnosed with perinatal anxiety was noted to be irregular even interprofessional communication proved difficult (Silverwood et al, 2019).…”

“…Based on the research in Sri Lanka, the midwife has delivered antenatal education to almost all pregnant women, and it has well developed infrastructure for mental health care for postpartum. However, the care practice of antenatal mental health has been not evaluated independently (Wyatt et al, 2022). In this study, 12 midwives have varied awareness level about prenatal depression and there is no diagnosis pattern, but it is consistent in midwife clinical procedures, following guidelines for referral and case management follow-up, and developing excellent relationships.…”

“…Due to the stigma and misunderstanding of mental illness, some families initially refused to accept the diagnosis or treat pregnant women cruelly. Meanwhile, family is eager to discuss the issue with health care providers, they try to hide it from the rest of the community (Wyatt et al, 2022). There are three main categories were identified: "challenges and differences when working during the pandemic", "emotional and mental health and well-being", and "the psychological distress of women observed by midwives" (González Timoneda et al, 2021).…”

“…They showed that with the application of standard diagnostic instruments and easier access to specialized care, treatment can be improved. We found that clinical guidelines for the diagnosis and treatment of prenatal depression are short in important data on symptoms for proper diagnosis but provide clear guidance on how to proceed with treatment (Wyatt et al, 2022). The anxiety is associated with feelings of guilt, hopelessness, sadness due to the death of family member so that it can affect mental health (Liu et al, 2021).…”

Acceptability and feasibility of a screening protocol for antenatal depression (SPADe) in Blantyre District, Malawi

“…However some midwives may consider screening for antenatal depression to be too demanding and requiring too much effort [14] suggesting limited feasibility and acceptability of depression screening in antenatal clinics. Conversely, evidence from the United Kingdom [15] and Sri Lanka [16] showed that midwives considered screening for depression in antenatal clinics as feasible and acceptable. In this study, feasibility refers to a process of determining whether an intervention can be shaped to be relevant and sustainable by identifying what aspects need modification and how changes might occur [17].…”