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Cited by 30Maternal Mental Health During Pregnancy and PostpartumMental Health Treatment and AccessGlobal Maternal and Child Health

Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

Open access
Tomlinson, Mark, Chaudhery, Deepika, Ahmadzai, Habibullah, Rodríguez Gómez, Sofía, Bizouerne, Cécile, van Heyningen, Thandi, Chopra, Mickey·2020·International Journal of Mental Health Systems
DOI 10.1186/s13033-020-00407-1PMC PMC7592367
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Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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  • Previous studies have highlighted higher rate of psychological disorder symptoms, including PTSD, among Afghan women compared to men.

    “Previous studies have also highlighted the higher rate of psychological disorder symptoms, including PTSD, among Afghan women compared to men (Jewkes et al., 2018; Paiman et al., 2019; Tomlinson et al., 2020; Kovess-Masfety et al., 2021).”

    From Traumatic Events, Post-Traumatic Stress Disorder, and Post-Traumatic Growth among University Students in Kabul City (2025) · cites this paper as Tomlinson et al., 2020

    The 'Maternal mental health in Afghanistan' section says mental health problems are nearly twice as common among women and reports higher rates of depression and anxiety among Afghan women. Neither that passage nor the retrieved passages establish a higher rate of PTSD symptoms among women than men. (LLM, conf=0.88)

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Research works printed but not linked: 23

  1. [2]Jansen S White R Hogwood J Jansen A Gishoma D Mukamana D The "treatment gap" in global mental health reconsidered: sociotherapy for collective trauma in Rwanda Eur J Psychotraumatol 2015 6 28706 10.3402/ejpt.v6.28706 26589258 PMC4654767 · DOI · Paper page
  2. [4]Lund C Brooke-Sumner C Baingana F Baron EC Breuer E Chandra P Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews Lancet Psychiatry 2018 5 4 357 369 10.1016/S2215-0366(18)30060-9 29580610 · DOI · Paper page
  3. [5]Azale T Fekadu A Hanlon C Postpartum depressive symptoms in the context of high social adversity and reproductive health threats: a population-based study Int J Ment Health Syst 2018 12 42 10.1186/s13033-018-0219-x 30069229 PMC6064119 · DOI
  4. [6]Heyningen TV Myer L Onah M Tomlinson M Field S Honikman S Antenatal depression and adversity in urban South Africa J Affect Disord 2016 203 121 129 10.1016/j.jad.2016.05.052 27285725 PMC5777271 · DOI
  5. [7]Fisher J Cabral de Mello M Patel V Rahman A Tran T Holton S Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review Bull World Health Organ. 2012 90 2 139G 49G 10.2471/BLT.11.091850 PMC3302553 22423165 · DOI · Paper page
  6. [8]Mitchell AJ Coyne JC Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies Br J General Pract 2007 57 535 144 151 PMC2034175 17263931
  7. [9]Ali GC Ryan G De Silva MJ Validated screening tools for common mental disorders in low and middle income countries: a systematic review PLoS ONE 2016 11 6 e0156939 10.1371/journal.pone.0156939 27310297 PMC4911088 · DOI · Paper page
  8. [10]United Nations Development Programme Human development report 2015: work for human development 2015 New York Springer
  9. [11]Kagee A Tsai AC Lund C Tomlinson M Screening for common mental disorders in low resource settings: reasons for caution and a way forward Int Health 2013 5 1 11 14 10.1093/inthealth/ihs004 23580905 PMC3619733 · DOI
  10. [12]Dixon S Dantas JA Best practice for community-based management of postnatal depression in developing countries: A systematic review Health Care Women Int 2017 38 2 118 143 10.1080/07399332.2016.1255213 27918855 · DOI
  11. [13]Sikander S Ahmad I Atif N Zaidi A Vanobberghen F Weiss HA Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan Lancet Psychiatry 2019 6 2 128 139 10.1016/S2215-0366(18)30467-X 30686386 · DOI
  12. [15]Loewenberg S Afghanistan's hidden health issue The Lancet 2009 374 9700 1487 1488 10.1016/S0140-6736(09)61887-0 19891039 · DOI
  13. [21]Vos T Flaxman AD Naghavi M Lozano R Michaud C Ezzati M Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2163 2196 10.1016/S0140-6736(12)61729-2 23245607 PMC6350784 · DOI · Paper page
  14. [22]Whiteford HA Degenhardt L Rehm J Baxter AJ Ferrari AJ Erskine HE Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 Lancet 2013 382 9904 1575 1586 10.1016/S0140-6736(13)61611-6 23993280 · DOI · Paper page
  15. [23]Kessler RC Epidemiology of women and depression J Affect Disord 2003 74 1 5 13 10.1016/S0165-0327(02)00426-3 12646294 · DOI · Paper page
  16. [25]Scholte WF Olff M Ventevogel P de Vries GJ Jansveld E Cardozo BL Mental health symptoms following war and repression in eastern Afghanistan JAMA 2004 292 5 585 593 10.1001/jama.292.5.585 15292084 · DOI
  17. [26]Panter-Brick C Eggerman M Gonzalez V Safdar S Violence, suffering, and mental health in Afghanistan: a school-based survey Lancet 2009 374 9692 807 816 10.1016/S0140-6736(09)61080-1 19699514 PMC2748901 · DOI
  18. [31]Parsons CE Young KS Rochat TJ Kringelbach ML Stein A Postnatal depression and its effects on child development: a review of evidence from low- and middle-income countries Br Med Bull 2012 101 57 79 10.1093/bmb/ldr047 22130907 · DOI
  19. [32]Rahman A Patel V Maselko J Kirkwood B The neglected 'm' in MCH programmes–why mental health of mothers is important for child nutrition Trop Med Int Health 2008 13 4 579 583 10.1111/j.1365-3156.2008.02036.x 18318697 · DOI
  20. [33]Honikman S van Heyningen T Field S Baron E Tomlinson M Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa PLoS Med 2012 9 5 e1001222 10.1371/journal.pmed.1001222 22666181 PMC3362637 · DOI
  21. [34]Larvin H Peckham E Prady SL Case-finding for common mental disorders in primary care using routinely collected data: a systematic review Soc Psychiatry Psychiatr Epidemiol 2019 54 10 1161 1175 10.1007/s00127-019-01744-4 31300893 · DOI
  22. [35]Hengartner MP Lehmann SN Why psychiatric research must abandon traditional diagnostic classification and adopt a fully dimensional scope: two solutions to a persistent problem Front Psychiatry 2017 8 101 10.3389/fpsyt.2017.00101 28638352 PMC5461269 · DOI
  23. [36]Fujita N Zwi AB Nagai M Akashi H A comprehensive framework for human resources for health system development in fragile and post-conflict states PLoS Med 2011 8 12 10.1371/journal.pmed.1001146 PMC3243715 22205886 · DOI

Cited by

Sorted by citations

Authors
Tomlinson, M., Chaudhery, D., Ahmadzai, H., Rodríguez Gómez, S., Bizouerne, C., van Heyningen, T., & Chopra, M.
Affiliations
  • Queen's University Belfast (GB)
  • World Bank (US)
  • University of Cape Town (ZA)
Corresponding author
Tomlinson, Mark
ORCID
Venue
International Journal of Mental Health Systems
Publisher
Springer Science and Business Media LLC
Published
2020-10-27
Volume
14
Issue
1
Pages
75-75
ISSN
1752-4458 (ISSN-L)
DOI
10.1186/s13033-020-00407-1
PMC
PMC7592367
OpenAlex
W3096456827
Cited by
30
References
4
Citations by year
2026: 4 · 2025: 6 · 2024: 12 · 2023: 2 · 2022: 5 · 2020: 1
FWCI
1.50
Type
journal article
Language
en
Update notices
correction (2020-11-19)
Open access
Licence
Locations
  • International Journal of Mental Health Systems (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (acceptedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Open University of Cape Town (University of Cape Town) (submittedVersion)
  • SUNScholar (Stellenbosch University) (submittedVersion)
Funders
World Bank Group
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
maternal mental health, postpartum depression, postpartum depression screening, PHQ-9, psychological intervention, resource-limited settings, primary care, non-specialist health workers, suicidal ideation, intimate partner violence, trauma, home visiting, Afghanistan

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