Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan – a multi-method study Original contribution First Online: 06 August 2007 Received: 16 November 2006 Accepted: 30 June 2007 DOI:
Cite this article as: Rahman, A. Arch Womens Ment Health (2007) 10: 211. doi:10.1007/s00737-007-0193-9 Summary
Perinatal depression, due to its high prevalence and associations with disability, poor infant development and family disruption, is a major public health problem in developing countries. In non-literate and poor communities where depression is not recognised and where there are no specialists, developing a culturally acceptable, deliverable psychological intervention that community members find useful, presents special challenges but also opportunities.
We describe lessons learned from a multi-method formative study to develop and deliver a psychological intervention to depressed mothers and their infants through non-specialist village based health workers.
Keywords: Perinatal depression; mental health; intervention; women; developing countries References Ali, BS, Naeem, S, Gul, A, Mubeen, S, Iqbal, A 2003 The effectiveness of counselling on anxiety and depression by minimally trained counsellors Am J Psychother 57 324 336 PubMed Google Scholar Araya, R, Rojas, G, Fritsch, R, Gaete, J, Rojas, M, Simon, G, Peters, TJ 2003 Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial Lancet 361 995 1000 PubMed CrossRef Google Scholar Austin, M-P, Priest, SR 2005 Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders Acta Psychiatr Scand 112 97 104 PubMed CrossRef Google Scholar Beck, AT, Rush, AJ, Shaw, BR 1979Cognitive therapy for depression Wiley New York Google Scholar Bolton, P, Bass, J, Neugebauer, R, Verdeli, H, Clougherty, KF, Wickramaratne, P, Speelman, L, Ndogoni, L, Weissman, M 2003 Group interpersonal psychotherapy for depression in rural Uganda JAMA 289 3117 3124 PubMed CrossRef Google Scholar Butler, AC, Chapman, JE, Forman, EM, Beck, AT 2006 The empirical status of cognitive-behavioral therapy: a review of meta-analyses Clin Psychol Rev 26 17 31 PubMed CrossRef Google Scholar Claeson, M, Waldman, RJ 2000 The evolution of child health programmes in developing countries: from targeting diseases to targeting people Bull World Health Organ 78 1234 1245 PubMed Google Scholar Cooper, PJ, Tomlinson, M, Swartz, L, Woolgar, M, Murray, L, Molteno, C 1999 Post-partum depression and the mother-infant relationship in a South African peri-urban settlement Br J Psychiatry 175 554 558 PubMed CrossRef Google Scholar Desjarlais, R, Eisenberg, L, Good, B, Kleinman, A 1995World mental health: problems and priorities in low income countries Oxford University Press Oxford Google Scholar Edhborg, M, Friberg, M, Lundhi, L, Widstrom, A-M 2005 “Struggling with life”: narratives from women with signs of postpartum depression Scand J Publ Health 33 261 267 CrossRef Google Scholar Evans, J, Heron, J, Francomb, H, Oke, S, Golding, J 2001 Cohort study of depressed mood during pregnancy and after childbirth BMJ 323 257 260 PubMed CrossRef Google Scholar Ghubash, R, Abou-Saleh, MT 1997 Postpartum psychiatric illness in Arab culture: prevalence and psychosocial correlates Br J Psychiatry 171 66 68 Google Scholar
Government of Pakistan (1999) District census report of Rawalpindi. Population Census Organization, Islamabad
Harpham, T, Huttly, S, De Silva, MJ, Abramsky, T 2005 Maternal mental health and child nutritional status in four developing countries J Epidemiol Commun Health 59 1060 1064 CrossRef Google Scholar Lopez, A, Mathers, C, Ezzati, M, Jamison, D, Murray, C 2006Global burden of disease and risk factors Oxford University Press and the World Bank Washington CrossRef Google Scholar Murray, L, Cooper, P 1997Postpartum depression and child development Guilford New York Google Scholar Oates, MR Cox, JL Neema, S Asten, P Glangeaud-Freudenthal, N Figueiredo, B Gorman, LL Hacking, S Hirst, E Kammerer, MH Klier, CM Seneviratne, G Smith, M Sutter-Dallay, AL Valoriani, V Wickberg, B Yoshida, K TCS-PND Group 2004 Postnatal depression across countries and cultures: a qualitative study Br J Psychiatry 184 10 16 CrossRef Google Scholar O’Hara, MW, Swain, AM 1996 Rates and risk of postpartum depression: a meta-analysis Int Rev Psychiatry 8 37 54 Google Scholar Patel, V 2000 The need for treatment evidence for common mental disorders in developing countries Psychol Med 30 743 746 PubMed CrossRef Google Scholar Patel, V, Rodrigues, M, DeSouza, N 2002 Gender, poverty, and postnatal depression: a study of mothers in Goa, India Am J Psychiatry 159 43 47 PubMed CrossRef Google Scholar Patel, V, Rahman, A, Jacob, KS, Hughes, M 2004 Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia BMJ 328 820 823 PubMed CrossRef Google Scholar Rahman, A 2005 Maternal depression and child health: the need for holistic health policies in developing countries Harvard Health Policy Rev 6 70 80 Google Scholar Rahman, A, Mubbashar, MH, Gater, R, Goldberg, D 1998 Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan Lancet 352 1022 1025 PubMed CrossRef Google Scholar Rahman, A, Iqbal, Z, Harrington, R 2003 Life events, social support and depression in childbirth: perspectives from a rural community in the developing world Psychol Med 33 1161 1167 PubMed CrossRef Google Scholar Rahman, A, Iqbal, Z, Bunn, J, Lovel, H, Harrington, R 2004 Impact of maternal depression on infant nutritional status and illness: a cohort study Arch Gen Psychiatry 61 946 952 PubMed CrossRef Google Scholar Rodrigues, M, Patel, V, Jaswal, S, de Souza, N 2003 Listening to mothers: qualitative studies on motherhood and depression from Goa, India Soc Sci Med 57 1797 1806 PubMed CrossRef Google Scholar Small, R, Brown, S, Lumley, J, Astbury, J 1994 Missing voices: what women say and do about depression after childbirth J Reprod Infant Psychol 12 89 103 Google Scholar Sumathipala, A, Hewege, S, Hanwella, R, Mann, AH 2000 Randomized controlled trial of cognitive behaviour therapy for repeated consultations for medically unexplained complaints: a feasibility study in Sri Lanka Psychol Med 30 747 757 PubMed CrossRef Google Scholar
United Nations (2001) Road map towards the implementation of the United Nations millennium declaration: report of the secretary-general. United Nations, New York
World Health Organization (1994) SCAN: schedule for clinical assessment in neuropsychiatry. World Health Organization, Geneva