Integrating perinatal mental healthcare into maternal and perinatal services in low and middle income countries

Manolova, Gergana; Ahmed, Waqas; Chowdhary, Neerja; Salisbury, Tatiana Taylor; Dua, Tarun

doi:10.1136/bmj-2022-073343

Cited by 15 publications

(7 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, our findings show that anxiety disorders may add significantly to the burden of perinatal mental health disorders in LMICs, and this burden needs urgent attention. The integration of perinatal mental health care into universal maternal and child health services is crucial . Screening and treatment options are needed that are culturally appropriate and that cover the breadth of mental health disorders, including anxiety and related disorders, and not simply depression.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries

Roddy Mitchell,

Gordon,

Atkinson

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceAnxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear.ObjectiveTo conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs.Data SourcesEmbase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023.Study SelectionStudies conducted in World Bank–defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder.Main Outcomes and MeasuresMain outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs.ResultsAt total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle–income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle–income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries.Conclusions and RelevanceThese findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries

Roddy Mitchell,

Gordon,

Atkinson

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…In this context, Manolova and colleagues (2023) talk about the concept of “voltage drop”, where a program with high efficacy may not achieve high effectiveness in the real world ( 24 ). Studies evaluating (cost)effectiveness and feasibility of existing interventions and programmes are both important for care development and often lacking.…”

Section: Future Directionsmentioning

confidence: 99%

State of perinatal mental health care in the WHO region of Europe: a scoping review

Horakova,

Nemcova,

Hrdlickova

et al. 2024

Front. Psychiatry

View full text Add to dashboard Cite

BackgroundAlthough perinatal mental disorders are the most common health complication among women in the perinatal period, there is a huge gap in the implementation of related research findings in the health care system. We mapped the state of perinatal mental health (PMH) care in the WHO Europe region with aim to identify leading countries, which can serve as models for countries with less developed perinatal mental health care.MethodsGuidelines, policies, and documents related to screening and treatment services for PMH were searched as grey literature. Results were analysed to assess the status of PMH care in the WHO European countries and to identify gaps (absence of relevant service or documents). The state of perinatal mental health care was scored on a 0-5 scale.ResultsThe grey literature search resulted in a total of 361 websites. Seven countries (Belgium, Finland, Ireland, Netherlands, Sweden, UK, Malta) received full points for the presence of relevant PMH services or documents, while five countries received zero points. Most WHO European countries (48/53) have general mental health policies, but only 25 countries have policies specifically on perinatal mental health. Ten countries offer PMH screening, and 11 countries offer PMH service (of any type). Any PMH guidelines were provided in 23/53 countries.ConclusionsPerinatal mental health care is in its infancy in most WHO European countries. Leading countries (Belgium, Finland, Ireland, Netherlands, Sweden, UK, Malta) in PMH care can serve as conceptual models for those less developed and geopolitically close.

show abstract

“…Ransing et al (2020) reported that a wide knowledge gap about perinatal depression exists among perinatal women, nurses, and medical practitioners. There are not adequate healthcare providers trained in maternal, newborn, and child mental health, which goes a long way to affect services' ability to identify mental health conditions, provide psychosocial interventions for their prevention and management, and make referrals appropriately (Manolova et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Utilization of Perinatal Depression and Anxiety Assessment Tools in Routine Perinatal Care: a Call for the Integration and Implementation of Maternal Mental Health Services Into Perinatal Care in Ghana.

Karikari,

fuseini,

Bessing

et al. 2024

Preprint

View full text Add to dashboard Cite

Background This study intends to stimulate critical thinking and generate impactful discussions on the provision of holistic perinatal care. The rationale is to promote the exchange of ideas and collaboration among stakeholders to ensure that the training and practice of midwifery in Ghana become more robust and meet global standards. Additionally, it is meant to inform, prepare competent, resourceful, knowledgeable, and most importantly adaptable midwives who can contribute to and promote the overall health of the women in their care. Objective To explore midwives’ knowledge and understanding on soliciting the requisite information that impacts the psychological health of the perinatal women in their care during the perinatal period using globally validated and reliable assessment tools for depression and anxiety. Methods A structured questionnaire was used to collect data from the participants (midwives). The study was conducted in selected hospitals across all 16 regions in Ghana. A total of 319 midwives with varying degrees and experience working at different levels (teaching, municipal, regional and district hospitals) of the health care system in Ghana participated in the study. Basic descriptive quantitative analysis was used based on frequency tables, pie chart and graphical illustration to interpret the data. Results The participants have adequate knowledge on the impact of perinatal anxiety and depression on birth and maternal outcomes. However, the remains a huge deficit in their ability to use the validated and reliable assessment tools in recognizing clinical cues related to anxiety and depression among perinatal women. Surprisingly, over 50% of the midwives were unfamiliar with the commonly used assessment tools for depression and anxiety such as the EPDS and PHQ-9. Additionally, nearly 40% of the participants lack the requisite assessment skills for assessing perinatal anxiety and depression. Conclusion Perinatal mental health should be made a critical component of perinatal care, with midwives being well situated to recognize the manifestations of deteriorating mental health among the perinatal women in their care and provide the needed support and required level of supervision. It is therefore imperative to train midwives on basic mental health assessment skills and encourage them to incorporate mental health care into the delivery of routine perinatal care and services.

show abstract

Integrating perinatal mental healthcare into maternal and perinatal services in low and middle income countries

Abstract: Gergana Manolova and colleagues argue for a comprehensive approach to the challenge of treating perinatal mental health conditions in maternal, neonatal, and child health services

Cited by 15 publications

References 25 publications

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries

State of perinatal mental health care in the WHO region of Europe: a scoping review

Utilization of Perinatal Depression and Anxiety Assessment Tools in Routine Perinatal Care: a Call for the Integration and Implementation of Maternal Mental Health Services Into Perinatal Care in Ghana.

Contact Info

Product

Resources

About