Addressing the treatment gap for perinatal depression within an integrated primary health care model was the focus of a doctoral thesis.
The work earned a PhD in Psychology for Dr Tasneem Kathree, Project Manager for the Southern African Research Consortium for Mental Health INTegration (S-MhINT) at UKZN’s Centre for Rural Health.
Perinatal depression (PND) is a common mental disorder (CMD) with onset either during pregnancy or in the postnatal period, with potentially harmful inter-generational impacts on families, and – by extension – on communities. In South Africa a combination of high prevalence rates for PND, an estimated treatment gap of 75 percent for CMDs, and a large medically uninsured population, pose a public health and social burden.
‘A lack of awareness of and minimal attention paid to PND in scarce-resourced primary health care (PHC) settings in South Africa compound the issue. Consequently, screening, referral and treatment for PND is low to absent, as are targeted pharmacological and psychosocial therapies for PND,’ said Kathree.
Internationally, evidence supports the concepts of both collaborative care and task-sharing to address PND in low-and middle-income countries (LMIC). ‘In South Africa however, despite support for the integration of mental health services into general health care, promotion of perinatal mental health care – and endorsement of task-sharing in mental health care, promoted by a national mental health policy framework – there is an absence of clear strategies to address PND in the mandated maternity care guidelines in PHC,’ she said.
In response to this service and evidence gap, the aim of her study was to co-develop and evaluate the feasibility of a culturally and contextually appropriate integrated model of care for PND with PHC service users and service providers.
Kathree suggests that key policy level changes are required including but not confined to the adoption and reporting of mental health data elements and indicators for PND, and adaptations to the maternity guidelines to include detection in the form of brief screening, assessment, diagnosis and referral for PND.
‘With reference to task-shared mental health care, the inclusion of social workers in counselling treatment plans, and the identification of appropriate cadres, trainers, training, and supervision for non-specialist mental health counsellors, are critical factors requiring concerted political will and effort,’ she added.
Kathree thanked her family, friends and supervisor for their support during her PhD journey.