“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

Abstract

Background Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia. Methods We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis. Results The study identified: (i) health administrators’ low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals’ commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation. Conclusions This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.

Assessment of Postpartum Depression Screening Practice and Associated Factors among Physicians in Gynecology and Obstetrics Department of Tertiary Hospitals in Southern and Central Ethiopia

“…In a study conducted in Kaduna, Nigeria, only 8.9% was screened which is lower than our finding (26). Qualitative studies conducted on Perinatal depression screening practice in Amhara Regional State, Ethiopia, share common barriers with our study findings: health administrators' low literacy, community awareness, and organizational challenges (38). A qualitative descriptive study done in Victoria, Australia indicated language barrier between professionals and patients also factor influencing screening practice (39).…”

Internalised stigma among people with mental illness in Africa, pooled effect estimates and subgroup analysis on each domain: systematic review and meta-analysis

“…It has been alluded that variations in cultural views on stigma within countries, levels of poverty and access to mental health services, may be contributory factors to these differences [ 91 ]. In some countries including Ethiopia, a mental illness may not be regarded as a life-threatening condition [ 91 , 92 ]. As such, policymakers and planners and health care providers may not prioritised mental health care and treatment [ 93 , 94 ].…”

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.

“…In Africa, Maternal Mental Health Services (MMHS) is seriously lacking within the entire healthcare space due to numerous factors and challenges. Barriers to poor treatment are multifactorial and could be associated with personal behaviour, the severity of the disorder, social norms, and the lack of effective mental health care systems (Dadi et al, 2021). The issue of Maternal Mental Health Services (MMHS) is not deeply rooted in the Ghanaian health sector which is characteristically re ective of how mental health issues are poorly understood and handled in its entirety.…”