WEBB FELLOW: A Systematic Review of Perinatal Mental Health Care Interventions in Low- and Middle-Income Countries

Background: Women in low- and middle-income countries (LMICs) are disproportionally affected by perinatal mental illness due to risk factors, such as early life abuse, intimate partner violence, poverty, and lower education levels. Perinatal depression prevalence, for instance, ranges from 20 to 25% in LMICs (1). Despite this immense burden of illness, most women in LMICs do not get treatment due to lack of mental health care access (i.e., 0.1-1.2 psychiatrists per 100,000 people) (3). Integrating mental health care into routine perinatal care is recommended to address the gap in mental health care access in under-resourced settings (2). However, there is a lack of systematic evaluation of these interventions in LMICs. Understanding the effectiveness of integrated care interventions within LMICs is critical to inform intervention development, implementation, and scale-up. This systematic review aims to assess the effectiveness of interventions that integrate mental health care into routine clinical care to improve maternal mental health and infant health outcomes as compared to usual care during the perinatal period in LMICs.

Methods: A systematic review was conducted in accordance with the 2009 PRISMA statement seeking assessments of structured perinatal mental health care interventions targeting depression and anxiety and integrated into routine clinical care in LMICs. The search was conducted using electronic databases Medline, PsycINFO, Web of Science, EMBASE and the Global Health Library using search terms under 4 broad categories: (1) “mental health,” (2) “low- and middle- income country,” (3) “pregnancy,” and (4) “intervention.” Abstracts were independently reviewed utilizing Covidence Review Software by two authors and then full text articles were further reviewed for inclusion and data was extracted. Extracted data included study design, study setting, sample characteristics, intervention type, personnel, target population, target disorder, and outcome measures.

Findings/Discussion: The initial search revealed 2382 unique citations. Fifty-eight full text articles were screened for eligibility and 33 studies met inclusion criteria. Final data assessment is currently ongoing. Preliminary findings demonstrate that the target of most interventions was perinatal depression prevention and mild depression treatment, with few addressing severe perinatal depression or pharmacologic treatments. Most interventions were focused on psychoeducation and adapted counseling and few utilized more traditional integrated care models (e.g., stepped-care). Results will serve to inform future evidence-based intervention development, implementation, and scale-up in LMICs. 

References:

1. Gelaye B, Rondon M, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973-982.


2. Lasater ME, Beebe M, Gresh A, Blomberg K, Warren N. Addressing the unmet need for maternal mental health services in low- and middle-income countries: Integrating mental health into maternal health care. J Midwifery Womens Health. 2017; 62(6):657-660.


3. WHO. The Global Burden of Disease: 2004 Update. Geneva, Switzerland; 2008.