Addressing the challenges of integrating care for perinatal depression in primary care in Nigeria.

IF 3.6 2区医学 Q1 PSYCHIATRY Social Psychiatry and Psychiatric Epidemiology Pub Date : 2024-10-01 Epub Date: 2024-02-08 DOI:10.1007/s00127-024-02611-7

Bibilola D Oladeji, Olatunde O Ayinde, Toyin Bello, Lola Kola, Neda Faregh, Jibril Abdulmalik, Phyllis Zelkowitz, Soraya Seedat, Oye Gureje

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Abstract

Purpose: This report provides the results of a task-shared approach for integrating care for perinatal depression (PND) within primary maternal and child healthcare (PMCH), including the factors that may facilitate or impede the process.

Methods: This hybrid implementation-effectiveness study guided by the Replicating Effective Programmes framework was conducted in 27 PMCH clinics in Ibadan, Nigeria. The primary implementation outcome was change in the identification rates of PND by primary health care workers (PHCW) while the primary effectiveness outcome was the difference in symptom remission (EPDS score ≤ 5) 6 months postpartum. Outcome measures were compared between two cohorts of pregnant women, one recruited before and the other after training PHCW to identify and treat PND. Barriers and facilitators were explored in qualitative interviews.

Results: Identification of PND improved from 1.4% before to 17.4% after training; post-training rate was significantly higher in clinics where PHCW routinely screened using the 2-item patient health questionnaire (24.8%) compared to non-screening clinics (5.6%). At 6-months postpartum, 60% of cohort one experienced remission from depression, compared to 56.5% cohort two [OR-0.9 (95%CI-0.6, 1.3) p = 0.58]. Identified facilitators for successful integration included existence of policy specifying mental health as a component of PHC, use of screening to aid identification and supportive supervision, while barriers included language and cultural attitudes towards mental health and human resource constraints. PHCW were able to make adaptations to address these barriers.

Conclusions: Successful implementation of task-shared care for perinatal depression requires addressing staff shortages and adopting strategies that can improve identification by non-specialist providers.

Trial registration: This study was retrospectively registered 03 Dec 2019. https://doi.org/10.1186/ISRCTN94230307 .

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应对尼日利亚初级保健中围产期抑郁症综合护理的挑战。

目的：本报告介绍了将围产期抑郁症（PND）护理纳入初级母婴保健（PMCH）的任务分担方法的结果，包括可能促进或阻碍该过程的因素：这项混合实施效果研究以 "复制有效计划 "框架为指导，在尼日利亚伊巴丹的 27 家初级母婴保健诊所开展。主要实施结果是初级卫生保健工作者（PHCW）对 PND 识别率的变化，而主要效果结果是产后 6 个月症状缓解率（EPDS 评分≤ 5 分）的差异。对两组孕妇的疗效进行了比较，一组是在对初级保健工作者进行识别和治疗 PND 的培训之前招募的孕妇，另一组是在对初级保健工作者进行识别和治疗 PND 的培训之后招募的孕妇。在定性访谈中探讨了障碍和促进因素：PND 的识别率从培训前的 1.4% 提高到培训后的 17.4%；与未进行筛查的诊所（5.6%）相比，PHCW 使用 2 项患者健康问卷进行常规筛查的诊所（24.8%）的 PND 识别率在培训后明显更高。产后 6 个月时，第一组有 60% 的产妇抑郁症得到缓解，而第二组为 56.5% [OR-0.9 (95%CI-0.6, 1.3) p = 0.58]。已确定的成功整合的促进因素包括将心理健康作为初级保健的一个组成部分的政策、使用筛查来帮助识别和支持性监督，而障碍则包括对心理健康的语言和文化态度以及人力资源限制。初级保健工作者能够通过调整来解决这些障碍：结论：围产期抑郁症任务分担护理的成功实施需要解决人员短缺问题，并采取能提高非专业医疗服务提供者识别能力的策略：本研究于 2019 年 12 月 3 日进行了回顾性注册。https://doi.org/10.1186/ISRCTN94230307 。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Social Psychiatry and Psychiatric Epidemiology 医学-精神病学

CiteScore

8.50

自引率

2.30%

发文量

184

审稿时长

3-6 weeks

期刊介绍： Social Psychiatry and Psychiatric Epidemiology is intended to provide a medium for the prompt publication of scientific contributions concerned with all aspects of the epidemiology of psychiatric disorders - social, biological and genetic. In addition, the journal has a particular focus on the effects of social conditions upon behaviour and the relationship between psychiatric disorders and the social environment. Contributions may be of a clinical nature provided they relate to social issues, or they may deal with specialised investigations in the fields of social psychology, sociology, anthropology, epidemiology, health service research, health economies or public mental health. We will publish papers on cross-cultural and trans-cultural themes. We do not publish case studies or small case series. While we will publish studies of reliability and validity of new instruments of interest to our readership, we will not publish articles reporting on the performance of established instruments in translation. Both original work and review articles may be submitted.