The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery. This exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme. Of the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention. In poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce.

中文翻译：

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识别和治疗阿富汗孕产妇心理健康问题：可行性研究

低收入和中等收入国家的精神障碍负担过重，再加上资源极度缺乏，需要一种创新的干预和应对方法。本研究评估了在资源严重受限的环境中作为常规服务提供的一部分提供孕产妇心理健康服务的可行性。这项探索性可行性研究是在阿富汗的两个没有专业精神卫生工作者的卫生设施中进行的。在过去 12 个月内分娩的妇女接受了 PHQ9 的抑郁症状筛查，并被邀请参加通过婴儿喂养计划提供的心理干预。在接受筛查的 215 名女性中，131 名 (60.9%) 符合 PHQ9 转诊至干预的标准。产后抑郁症的筛查率为 61%，使用 PHQ9 截止分数 12。此外，29% 的女性在 PHQ9 上登记为有自杀倾向。该样本中的一些人口统计学和社会心理变量与抑郁症状相关，包括婴儿的营养状况、焦虑症状、植物人和情绪症状、婚姻困难、亲密伴侣暴力、社会孤立、急性压力和创伤经历。在参加了所有六次干预的 47 名 (65%) 女性中，干预后的 PHQ9 分数均显着下降。在资源贫乏的环境中，产后抑郁症的患病率很高，将响应从基于专家的干预转变为初级卫生保健水平的干预可能是提供孕产妇心理保健的可行方式。建议此类计划也考虑到家访的组成部分，并将其纳入现有的婴儿和儿童健康计划。由非专业卫生工作者提供的基于证据的手动心理干预可以改善资源稀缺的结果。