Perinatal Depression: Screen and Management of Depression within Primary Care system

Background

Worldwide, 322 million people suffer from depression, an affective mood disorder that will become the second leading cause of disease by 2020. A third of this burden resides in China. Women are at higher risk of depression than men and their vulnerability to depression is intensified during pregnancy (antenatal depression) and transition to motherhood (postnatal depression). In low- and middle-income countries the prevalence of antenatal depression and postpartum depression is 19% to 25% and 20%, respectively. These rates are higher than the antenatal (7% to 15%) and postnatal (10%) depression rates reported for high-income countries but are comparable to high-risk populations in high-income countries.

In China, antenatal depression rates have ranged from 6% to 28%[8-10] while postnatal depression rates have ranged from 10% to 28% in the first year postpartum. Despite the high rates of antenatal and postnatal depression, referred to as perinatal depression, women’s mental health needs are unmet given lack of investment in mental health, unequal distribution of mental health services, and limited human resources (i.e., trained or specialized healthcare provider) to deal with mental health issues. Perinatal depression is a public health issue given its impact on maternal health during pregnancy (e.g., pregnancy-related complications such as gestational hypertension), pregnancy outcomes (e.g., preterm birth), breastfeeding initiation rates and infant mortality and morbidity (e.g., emotional disorders, disruptive behaviors in childhood, and academic performance).

Antenatal depression influences health care utilization, specifically increases in non-scheduled antenatal care and emergency care because of pregnancy-related emergencies and decrease preventative services for infant/child (e.g., well-child visits, vaccination clinics).

Aims

• Primary aim
  Implement an effective perinatal depression screening and management (PDSM) program within the primary health care system in several cities in Anhui province, China.

• Secondary aim
  Continually evaluate and improve PDSM program features to ensure PDSM program effectiveness and uptake, through usage of implementation science frameworks (i.e., RE-AIM, CFIR) and research team consultations.

• Other aim(s)
  Ensure long-term sustainability of the PDSM program within the Anhui health system and/or national maternal and child health system.

Project plan

This PDSM program entailed three phases:

1. project planning and development of PDSM pathway in consultation with stakeholders;

2. a pilot study in Ma’anshan;

3. Scale-up in 3 cities – Hefei, Bengbu, and Fuyang.

Evaluation of the PDSM employs mixed methods and implementation science research frameworks (Consolidated Framework for Implementation Research or CFIR and RE-AIM or Reach x Efficacy, Adoption, Implementation, and Maintenance).

Impact

The project team trained healthcare practitioners in China to deliver the ‘Thinking Healthy Program’ to women seeking perinatal care (pregnancy and postpartum) at maternal and child health care centers. The team translated and adapted the successful English language programme ‘Mom’s Good Mood’ for delivery within primary care in China.

Funding organisations

• 
•