Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan

Culturally adapted psychological intervention for treating maternal depression in British mothers of African and Caribbean origin: A randomized controlled feasibility trial

BACKGROUND

Women are likely to suffer from maternal depression due to childbirth difficulties and parenting responsibilities, leading to long-term negative consequences on their children and families. British mothers of African/Caribbean origin uptake of mental healthcare is low due to the lack of access to culturally appropriate care.

METHODS

A mixed-methods randomized controlled feasibility trial was adopted to test the appropriateness and acceptability of Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) for treating maternal depression compared with Psychoeducation (PE). Mothers (N = 26) aged 20-55 were screened for depression using the Patient Health Questionnaire (PHQ-9). Those who scored >5 on PHQ-9 were further interviewed using the Revised Clinical Interview Schedule to confirm the diagnosis and randomized into LTP+CaCBT (n = 13) or PE (n = 13) groups. Assessments were taken at baseline, end of the intervention at 3- and 6-months post-randomization. N = 2 focus groups (LTP+CaCBT, n = 12; PE, n = 7) and N = 8 individual interviews were conducted (LTP+CaCBT, n = 4; PE, n = 4).

RESULTS

The LTP+CaCBT group showed higher acceptability, feasibility and satisfaction levels than the PE group. Participants experienced the intervention as beneficial to their parenting skills with reduced depression and anxiety in the LTP+CaCBT compared to the PE group.

CONCLUSIONS

This is the first feasibility trial of an integrated online parenting intervention for British African and Caribbean mothers. The results indicated that culturally adapted LTP+CaCBT is acceptable and feasible. There is a need to study the clinical and cost-effectiveness of LTP+CaCBT in an appropriately powered randomized control trial and include the child's outcomes.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov (no. NCT04820920).

Building Resilience Against ViolencE (BRAVE): protocol of a parenting intervention for mothers and fathers with post-traumatic stress disorder in Pakistan

Background

Prevalence of post-traumatic stress disorder (PTSD) is high in Pakistan both due to natural disasters and ongoing conflicts. Offspring of trauma survivors are at increased risk for mental and physical illnesses. Parental PTSD has been linked to troubled parent-child relationships, behaviour problems, trauma symptoms, and depression in children. This study aims to explore the acceptability, feasibility and indications of the effectiveness of group learning through play plus trauma-focused cognitive behaviour therapy (LTP Plus TF-CBT) for parents experiencing PTSD.

Methods/Design

This is a two-arm pilot cluster randomised controlled trial (RCT). We aim to recruit 300 parents with a diagnosis of PTSD. The screening will be done using the Impact of Event Scale-Revised. Diagnosis of PTSD will be confirmed using the Clinician-Administered PTSD Scale-5 (CAPS-5). Union Councils from Peshawar and Karachi will be randomised into either group LTP Plus TF CBT arm or treatment as usual (TAU). The intervention includes 12 sessions of LTP Plus TF-CBT delivered weekly in the first 2 months and then fortnightly in a group setting by trained psychologists. The groups will be co-facilitated by the community health workers (CHWs). Parents will be assessed at baseline and 4th month (end of the intervention), using the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) Scale, Client Service Receipt Inventory (CSRI), and Ages and Stages Questionnaire (ASQ-3).

Discussion

This trial would help build an understanding of the acceptability, feasibility and indications of the effectiveness of a low-cost parenting intervention.

The Prevalence of Postpartum Depression and the Related Risk Factors in Primary Health Care, Al-Madinah, Saudi Arabia

Background

The onset of depressed symptoms within six weeks of childbirth is described as postpartum depression (PPD). When compared to developed countries, resource-constrained countries have a higher prevalence of PPD. The purpose of this study was to determine the prevalence of PPD and the factors linked to it in primary health care in Al-Madinah, Saudi Arabia.

Methods

This descriptive cross-sectional study was carried out at the Academy of Family Medicine, Al-Madinah Almunawarah, between June 2021 and December 2021. The Arabic version of the validated Edinburg Postnatal Depression Scale was used to measure postpartum depression. SPSS version 26 (IBM Corp., Armonk, NY) was used to record and analyze the data.

Results

A total of 243 participants were included in this study. The mean age of the participants was 28.21±11.54 years. Most of the participants, 116(47.7%), were in the age group of 22-30 years. Most of the babies 176 (72.4%) were born via normal vaginal delivery (NVD) while only 67 (27.76%) were born via caesarian section. Most of the participants had an income of <5000 riyals in our study. In our study, the majority of the babies, 137 (56.4%), were breastfed. In our study, major depression was found in 77 (31.68%) participants while mild depression was present in 50 (20.57%) participants. The comparative analysis showed that previous children (p <0.001), support in caring (p = 0.02), income status (p = 0.003), and child health issues (p<0.001) were statistically significant.

Conclusion

The prevalence of postpartum depression was relatively high in our study. The number of prior children, child health, income status, and family support all have a positive association. In short, healthcare providers must pay special attention to the mental health needs of pregnant women in our settings.

Stigma of postpartum depression: The role of lady health workers in health care-A qualitative study

The researchers explore the stigma of postpartum depression and role of lady health workers in bringing the women to the health facility and following up on their treatment. In-depth interviews were conducted from the registered patients (n = 22), Lady Health Visitors (n = 2) and Lady Health Workers (LHWs) (n = 2) in a public primary and tertiary healthcare facility in peri-urban areas of district Rawalpindi, Pakistan. Stigma of depression and lack of awareness was perceived as one of the major reasons for women to struggle with the label of postpartum depression and seeking medical treatment. Lady health workers played a significant role in health education and bringing them to the health facility. The services rendered by LHWs can be enhanced through comprehensive training as they can play an effective role in spreading awareness and educating the patients of postpartum depression in peri-urban areas and their families, consequently, ensuring their treatment and its follow-up.

Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan

The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-structured (open and close-ended questions) interview toolkit. Content Analysis was carried out using information gathered from the unit of analysis. The study provided evidence of the existing gaps in one particular tertiary healthcare system, within Pakistan, concerning diagnosis and management of maternal depression. Results highlighted that providers were well-versed with explanations of maternal depression, the aftermath of it, and the current status of healthcare; however, they were minimally educated about the specifics and levels of treatment. The gathered information assisted in recommending steps to develop a service framework.

Postpartum Depression: Prevalence and Associated Risk Factors Among Women in Sindh, Pakistan

Introduction

Postpartum depression (PPD) is defined as the onset of depressive symptoms within six weeks of childbirth. PPD is more common in resource-constrained countries as compared to developed countries. The study aimed to evaluate the factors associated with PPD among women in Sindh, Pakistan.

Methods

A multi-centre, cross-sectional study was conducted at three major tertiary care setups in Sindh, Pakistan. All women presenting to the outpatient department within six weeks of giving live birth were eligible to participate. All women who had stillbirths, abortions, or were treated for a past psychiatric illness or neurological disease were excluded from the study. The Edinburgh postpartum depression scale (EPDS) was used as a screening tool. All socio-demographic factors were documented in a predefined pro forma. The data was analyzed using Statistical Package for Social Sciences (SPSS, Version 26, IBM, Chicago, IL).

Results

According to the Edinburgh postpartum depression scale (EPDS), the incidence of postpartum depression in the current study population was 19.3%. Of these, 12 (3.3%) women had persistently thought about self-harming. Over 100 women did not receive any formal education, constituting the majority of the study population. Formula milk feeding of the newborn was significantly associated with an increased frequency of postpartum depression (p= 0.0001).

Conclusion

The current study highlights the significant burden of postpartum depression in Pakistan. However, the present study failed to find any significant risk factors associated with postpartum depression. Only formula milk feeding was significantly associated with a higher frequency of PPD among study patients.