Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase
Background: Depression in pregnancy affects nearly one in five women in low- and middle-income countries and is associated with adverse obstetric and neonatal outcome. Burden of morbidity is high, but specialized mental health resources are meager. Effective low intensity psychosocial interventions...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Indian Journal of Social Psychiatry |
| Subjects: | |
| Online Access: | http://www.indjsp.org/article.asp?issn=0971-9962;year=2022;volume=38;issue=1;spage=12;epage=20;aulast=Kukreti |
| _version_ | 1811279346056298496 |
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| author | Prerna Kukreti Ramdas Ransing Pracheth Raghuveer Mahesh Mahdevaiah Smita N Deshpande Dinesh Kataria Manju Puri Omsai Ramesh Vallamkonda Sumit Rana Harish K Pemde Reena Yadav Shilpi Nain Shiv Prasad Bhavuk Garg |
| author_facet | Prerna Kukreti Ramdas Ransing Pracheth Raghuveer Mahesh Mahdevaiah Smita N Deshpande Dinesh Kataria Manju Puri Omsai Ramesh Vallamkonda Sumit Rana Harish K Pemde Reena Yadav Shilpi Nain Shiv Prasad Bhavuk Garg |
| author_sort | Prerna Kukreti |
| collection | DOAJ |
| description | Background: Depression in pregnancy affects nearly one in five women in low- and middle-income countries and is associated with adverse obstetric and neonatal outcome. Burden of morbidity is high, but specialized mental health resources are meager. Effective low intensity psychosocial interventions hold promise to fill the treatment gap for maternal depression. In this paper, we aim to describe the process of development of a stepped care model incorporating screening, providing brief intervention, and referral pathways developed for managing depression in pregnancy in antenatal care health facilities in India. Methodology: Using complex intervention development and evaluation method of Medical Research Council, United Kingdom, we searched evidence-based strategies from preexisting manuals, conducted formative research for need assessment and stakeholder engagement, and developed the intervention following an expert review panel. We conducted pilot testing to assess the feasibility and acceptability of intervention supplemented by three focused group discussions. Results: Manual review identified psychoeducation, empathetic listening, behavior activation, and supportive counseling as important elements. Need assessment revealed huge gap in perinatal mental health knowledge. Nearly 92% of total 272 perinatal women had poor awareness and 35%–70% of total 62 health-care providers had poor knowledge. In qualitative interview, women reported depressive symptoms as a normal part of pregnancy and had poor help seeking, behavior symptoms of depression were more prominent. A stepped care algorithm was developed for screening all expectant mothers in each trimester for depression using Patient Health Questionnaire-9 (PHQ-9). Women with PHQ-9 score >19 or reporting self-harm ideation were urgently referred to psychiatrist. Women with PHQ-9 score 5–19 were given brief intervention for depression in pregnancy intervention by antenatal nurse. The intervention developed consists of three sessions of psychoeducation, relaxation exercise, and mental health promotion, each lasting 20 min and at gap of 2 weeks each. Service providers and mothers reported good acceptability of psychosocial intervention and reported satisfaction with content and delivery of intervention. Conclusion: Low intensity brief psychosocial interventions can be adapted for implementation if relevant stakeholders are engaged at each step right from development of such as screening, intervention pathway to delivery, and effectiveness study. |
| first_indexed | 2024-04-13T00:53:00Z |
| format | Article |
| id | doaj.art-2b816495c6c749ac863c227fe0062d6e |
| institution | Directory Open Access Journal |
| issn | 0971-9962 |
| language | English |
| last_indexed | 2024-04-13T00:53:00Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Social Psychiatry |
| spelling | doaj.art-2b816495c6c749ac863c227fe0062d6e2022-12-22T03:09:48ZengWolters Kluwer Medknow PublicationsIndian Journal of Social Psychiatry0971-99622022-01-01381122010.4103/ijsp.ijsp_372_21Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phasePrerna KukretiRamdas RansingPracheth RaghuveerMahesh MahdevaiahSmita N DeshpandeDinesh KatariaManju PuriOmsai Ramesh VallamkondaSumit RanaHarish K PemdeReena YadavShilpi NainShiv PrasadBhavuk GargBackground: Depression in pregnancy affects nearly one in five women in low- and middle-income countries and is associated with adverse obstetric and neonatal outcome. Burden of morbidity is high, but specialized mental health resources are meager. Effective low intensity psychosocial interventions hold promise to fill the treatment gap for maternal depression. In this paper, we aim to describe the process of development of a stepped care model incorporating screening, providing brief intervention, and referral pathways developed for managing depression in pregnancy in antenatal care health facilities in India. Methodology: Using complex intervention development and evaluation method of Medical Research Council, United Kingdom, we searched evidence-based strategies from preexisting manuals, conducted formative research for need assessment and stakeholder engagement, and developed the intervention following an expert review panel. We conducted pilot testing to assess the feasibility and acceptability of intervention supplemented by three focused group discussions. Results: Manual review identified psychoeducation, empathetic listening, behavior activation, and supportive counseling as important elements. Need assessment revealed huge gap in perinatal mental health knowledge. Nearly 92% of total 272 perinatal women had poor awareness and 35%–70% of total 62 health-care providers had poor knowledge. In qualitative interview, women reported depressive symptoms as a normal part of pregnancy and had poor help seeking, behavior symptoms of depression were more prominent. A stepped care algorithm was developed for screening all expectant mothers in each trimester for depression using Patient Health Questionnaire-9 (PHQ-9). Women with PHQ-9 score >19 or reporting self-harm ideation were urgently referred to psychiatrist. Women with PHQ-9 score 5–19 were given brief intervention for depression in pregnancy intervention by antenatal nurse. The intervention developed consists of three sessions of psychoeducation, relaxation exercise, and mental health promotion, each lasting 20 min and at gap of 2 weeks each. Service providers and mothers reported good acceptability of psychosocial intervention and reported satisfaction with content and delivery of intervention. Conclusion: Low intensity brief psychosocial interventions can be adapted for implementation if relevant stakeholders are engaged at each step right from development of such as screening, intervention pathway to delivery, and effectiveness study.http://www.indjsp.org/article.asp?issn=0971-9962;year=2022;volume=38;issue=1;spage=12;epage=20;aulast=Kukretibrief intervention for depression in pregnancyformative researchperinatal depressionstepped-care model |
| spellingShingle | Prerna Kukreti Ramdas Ransing Pracheth Raghuveer Mahesh Mahdevaiah Smita N Deshpande Dinesh Kataria Manju Puri Omsai Ramesh Vallamkonda Sumit Rana Harish K Pemde Reena Yadav Shilpi Nain Shiv Prasad Bhavuk Garg Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase Indian Journal of Social Psychiatry brief intervention for depression in pregnancy formative research perinatal depression stepped-care model |
| title | Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase |
| title_full | Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase |
| title_fullStr | Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase |
| title_full_unstemmed | Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase |
| title_short | Stepped care model for developing pathways of screening, referral, and brief intervention for depression in pregnancy: A mixed-method study from development phase |
| title_sort | stepped care model for developing pathways of screening referral and brief intervention for depression in pregnancy a mixed method study from development phase |
| topic | brief intervention for depression in pregnancy formative research perinatal depression stepped-care model |
| url | http://www.indjsp.org/article.asp?issn=0971-9962;year=2022;volume=38;issue=1;spage=12;epage=20;aulast=Kukreti |
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