Implementing Guidelines to Manage Perinatal Depression: Exploration of the Healthcare Provider’s Perceptions

Saara Hatupopi; Hellena Nuumbosho; Matride Amwaalanga

doi:10.25159/2958-3918/16014

Authors

Saara Hatupopi University of Namibia
Hellena Nuumbosho University of Namibia
Matride Amwaalanga University of Namibia

DOI:

https://doi.org/10.25159/2958-3918/16014

Keywords:

depression, implementation, perinatal depression, perinatal period, perinatal guidelines

Abstract

Perinatal mental health guidelines are still lacking in more than 80% of low- and middle-income countries. World Health Organization has outlined the importance of an evidence-informed approach for developing and sustaining high-quality integrated mental health services for women during the perinatal period.

Method: The study explored healthcare providers' perceptions of implementing guidelines to manage perinatal depression in primary healthcare settings in Namibia. A qualitative, explorative, descriptive, and contextual design was applied to collect data from a purposively selected sample of 12 healthcare providers. This involved two focus groups with healthcare providers. Thematic analysis of the interview transcripts was conducted simultaneously with data collection.

Findings: The study highlighted three major themes for successfully implementing the guidelines to manage perinatal depression: the significance of implementing the guidelines, integration of the guidelines into perinatal care settings, and barriers to implementing the guidelines.

Conclusion: Healthcare providers were aware of poor maternal mental health provision within perinatal care settings and were ready to implement the guidelines to manage perinatal depression. Professional training and continuous education on perinatal depression are fundamental components in fostering quality of care and community awareness, as well as improving stigma within the community and healthcare providers.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders, 5(5) https://doi.org/10.1176/appi.books.9780890425596

Baron, E. C., Hanlon, C., Mall, S., Honikman, S., Breuer, E., Kathree, T., Luitel, N. P., Nakku, J., Lund, C., Medhin, G., Patel, V., Petersen, I., Shrivastava, S., & Tomlinson, M. (2016). Maternal mental health in primary care in five low-and middle-income countries: a situational analysis. BMC Health Services Research, 16(1), 1–16. https://doi.org/10.1186/s12913-016-1291-z

Burger, M., Hoosain, M., Einspieler, C., Unger, M., & Niehaus, D. (2020). Maternal, perinatal mental health and infant and toddler neurodevelopment-Evidence from low and middle-income countries. A systematic review. Journal of Affective Disorders, 268, 158–172. https://doi.org/10.1016/j.jad.2020.03.023

Chorwe-Sungani, G. & Chipps, J. (2017). A systematic review of screening instruments for depression for use in antenatal services in low-resource settings. BMC Psychiatry, 17(1), 1–10. https://doi.org/10.1186/s12888-017-1273-7

Davies L., Page, N., Glover, H., Sudbury, H. (2016). Developing a perinatal mental health module: An integrated care approach. British Journal of Midwifery, 24(2), 118–21. https://doi.org/10.12968/bjom.2016.24.2.118

Fletcher A., Murphy, M., Leahy‐Warren, P. (2021). Midwives’ experiences of caring for women’s emotional and mental well‐being during pregnancy. Journal of Clinical Nursing, 30(9–10):1403–16. https://doi.org/10.1111/jocn.1569

Gentile, S. (2017). Untreated depression during pregnancy: short- and long-term effects in offspring. A systematic review. Neuroscience, 342(9), 154–166. https://doi.org/10.1016/j.neuroscience.2015.09.001

Gressier, F., Guillard, V., Cazas, O., Falissard, B., Glangeaud-Freudenthal, N. M. -C., & Sutter-Dallay, A. -L. (2017). Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. Journal of Psychiatric Research, 84, 284–291. https://doi.org/10.1016/j.jpsychires.2016.10.009

Izutsu, T., Tsutsumi, A., Minas, H., Thornicroft, G., Patel, V., & Ito, A. (2015). Mental health and wellbeing in the Sustainable Development Goals. The Lancet Psychiatry, 2(12), 1052–1054. https://doi.org/10.1016/S2215-0366(15)00457-5

Kendig, S., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S., Simas, T. A. M., Frieder, A., Hackley, B., Indman, P., Raines, C., Semenuk, K., Wisner, K. L., & Lemieux, L. A. (2017). Consensus bundle on maternal mental health: perinatal depression and anxiety. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(2), 272–281. https://doi.org/10.1016/j.jogn.2017.01.001

Khanlari, S., Barnett AM, B., Ogbo, F.A & Eastwood, J. (2019). Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. BMC Pregnancy and Childbirth, 19(1), 1–11. https://doi.org/10.1186/s12884-019-2378-4

Manolova, G., Waqas, A., Chowdhary, N., Salisbury, T. T., & Dua, T. (2023). Addressing the Growing NCD Burden Among Women And Children: Integrating Perinatal Mental Healthcare into Maternal and Perinatal Services in low and middle-income countries. The BMJ, 381. https://doi.org/10.1136/bmj-2022-073343

Motrico, E., Moreno‐Peral, P., Uriko, K., Hancheva, C., Brekalo, M., Ajaz, E., Apter, G., Bramante, A., Conejo‐Cerón, S., Christoforou, A., Dikmen‐Yildiz, P., Evagorou, O., Fonseca, A., Lupattelli, A., Radoš, S. N., al Maach, N., Rodriguez‐Muñoz, M. F., Žutić, M., & Lambregtse‐van den Berg, M. P. (2022). Clinical practice guidelines with recommendations for peripartum depression: A European systematic review. Acta Psychiatrica Scandinavica, 146(4), 325–339. https://doi.org/10.1111/acps.13478

Ministry of Health and Social Services. (2017). Namibia 2014/15 Health Accounts Report. Windhoek: MOHSS. September, 1–64

Ng’oma, M., Meltzer-Brody, S., Chirwa, E., & Stewart, R. C. (2019). “Passing through difficult times”: Perceptions of perinatal depression and treatment needs in Malawi - A qualitative study to inform the development of a culturally sensitive intervention. PLoS one, 14(6), e0217102. https://doi.org/10.1371/journal.pone.0217102

Natamba, B. K., Achan, J., Arbach, A., Oyok, T. O., Ghosh, S., Mehta, S., Stoltzfus, R. J., Griffiths, J. K., & Young, S. L. (2014). Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and - uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study. BMC Psychiatry, 14(1),1–8. https://doi.org/10.1186/s12888-014-0303-y

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., Chisholm, D., Collins, P. Y., Cooper, J. L., Eaton, J., Herrman, H., Herzallah, M. M., Huang, Y., Jordans, M. J. D., Kleinman, A., Medina-Mora, M. E., Morgan, E., Niaz, U., Omigbodun, O., & Prince, M. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553–1598. https://doi.org/10.1016/S0140-6736(18)31612-X

Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins.

Pratico, S. (2019). Implementing a perinatal depression screening and treatment program in an obstetric health department setting. Jacksonville University.

Rahman, A., Surkan, P. J., Cayetano, C. E., Ragwatare, P., & Dickson, K. E. (2013). Grand challenges: Integrating maternal mental health into maternal and child health programs. Plos Medicine, 10(5), e100442. https://doi.org/10.1371/journal.pmed.1001442

Stewart, R.C, Umar, E, Tomenson, B & Creed, F. (2013). Validation of screening tools for antenatal depression in Malawi: a comparison of the Edinburgh postnatal depression scale and self-reporting questionnaire. Journal of Affective Disorders, 150(3), 1041–1047. https://doi.org/10.1016/j.jad.2013.05.036

Woody, C. A., Ferrari, A. J., Siskind, D. J., Whiteford, H. A., & Harris, M. G. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86–92. https://doi.org/10.1016/j.jad.2017.05.003

World Health Organization (WHO). 2022. Guide for integration of perinatal mental health in maternal and child health services. New York: WHO.