Academic journal article Bulletin of the World Health Organization

Interventions for Common Perinatal Mental Disorders in Women in Low-And Middle-Income Countries: A Systematic Review and Meta-analysis/Interventions Sur Les Troubles Mentaux Perinataux Communs Des Femmes Dans Les Pays a Faible et Moyen Revenus: Une Etude Systematique et Une Meta-Analyse/ Las Intervenciones Para Los Trastornos Mentales Perinatales Frecuentes En Mujeres De Paises De Ingresos Bajos Y Medios: Revision Sistematica Y Metaanalisis

Academic journal article Bulletin of the World Health Organization

Interventions for Common Perinatal Mental Disorders in Women in Low-And Middle-Income Countries: A Systematic Review and Meta-analysis/Interventions Sur Les Troubles Mentaux Perinataux Communs Des Femmes Dans Les Pays a Faible et Moyen Revenus: Une Etude Systematique et Une Meta-Analyse/ Las Intervenciones Para Los Trastornos Mentales Perinatales Frecuentes En Mujeres De Paises De Ingresos Bajos Y Medios: Revision Sistematica Y Metaanalisis

Article excerpt

Introduction

Perinatal mental health problems are common worldwide. (1) In high-income countries, about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression or anxiety. (2,3) A recent systematic review showed higher rates of common perinatal mental disorders (CPMDs) among women from low- and lower-middle-income countries, where the weighted mean prevalence of these disorders was found to be 15.6% (95% confidence interval, CI: 15.4-15.9) in pregnant women and 19.8% (95% CI: 19.5-20.0) in women who had recently given birth. (4) The review identified several risk factors for CPMDs among women: having a partner lacking in empathy or openly antagonistic; being a victim of gender-based violence; having belligerent in-laws; being socially disadvantaged; having no reproductive autonomy; having an unintended or unwanted pregnancy; having pregnancy-related illness or disability; receiving neither emotional nor practical support from one's mother, and giving birth to a female infant? The day-to-day interactions between neonates and their primary caregivers influence neurological, cognitive, emotional and social development throughout childhood. Maternal mental health problems are not only detrimental to a woman's health; they have also been linked to reduced sensitivity and responsiveness in caregiving and to higher rates of behavioural problems in young children. There is growing evidence that, in low- and middle-income (LAMI) countries, the negative effects of maternal mental disorders on the growth and development of infants and young children are independent of the influence of poverty, malnutrition and chronic social adversity. (5,6) In low-income settings, maternal depression has been linked directly to low birth weight and undernutrition during the first year of life, as well as to higher rates of diarrhoeal diseases, incomplete immunization and poor cognitive development in young children. (7-10)

In some high-income countries, including England and Australia, the detection and treatment of CPMDs are prioritized. (11) However, this is not so in most LAMI countries, where many other health problems compete for attention) Psycho-educational interventions that promote problem solving and a sense of personal agency and help to reframe unhelpful thinking patterns, including cognitive behaviour therapy and interpersonal therapy, have consistently proven effective in the management of CPMDs. (12,13) Although few LAMI countries have sufficient mental health professionals to meet their populations' mental health needs, (14) several have tried to deliver acceptable, feasible and affordable interventions based on evidence generated locally. (15) The aims of this study were to investigate systematically the evidence surrounding the impact of such interventions on women and their infants and on the mother-infant relationship, and to understand the feasibility of applying them in LAMI countries.

Methods

Search strategy

We conducted a systematic search, without language restrictions, of seven electronic bibliographic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, the British Nursing Index, the Allied and Complementary Medicine database and the Cochrane Central Register. The search terms were: depression, maternal depression, perinatal depression, postnatal depression, postpartum depression, common mental disorders, mental health and postpartum psychosis. These terms were individually combined with the terms randomized controlled trial, controlled clinical trial, clinical trials, evaluation studies, cross over studies AND with the names of countries classified as LAMI countries by the World Bank. (16) China is a middle-income country. Despite ambiguity in its economic status, we included Taiwan, China, in the middle-income category. We hand-searched the reference lists of all included articles. When necessary, we also approached experts to identify unpublished studies. …

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