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Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis

INTRODUCTION: The prevalence of depression among women in Pakistan ranges from 28% to 66%. There is a lack of structured mental healthcare provision at private primary care clinics in low-income urban settings in Pakistan. This study investigated the effectiveness and processes of a facility-based m...

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Autores principales: Owais, Syeda Somyyah, Horner, Ronnie D., Khan, Muhammad Amir, Kenison, Kelli, Probst, Janice C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10117980/
https://www.ncbi.nlm.nih.gov/pubmed/37091298
http://dx.doi.org/10.3389/fgwh.2023.1091485
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author Owais, Syeda Somyyah
Horner, Ronnie D.
Khan, Muhammad Amir
Kenison, Kelli
Probst, Janice C.
author_facet Owais, Syeda Somyyah
Horner, Ronnie D.
Khan, Muhammad Amir
Kenison, Kelli
Probst, Janice C.
author_sort Owais, Syeda Somyyah
collection PubMed
description INTRODUCTION: The prevalence of depression among women in Pakistan ranges from 28% to 66%. There is a lack of structured mental healthcare provision at private primary care clinics in low-income urban settings in Pakistan. This study investigated the effectiveness and processes of a facility-based maternal depression intervention at private primary care clinics in low-income settings. MATERIALS AND METHODS: A mixed-methods study was conducted using secondary data from the intervention. Mothers were assessed for depression using the Patient Health Questionnaire-9 (PHQ-9). A total of 1,957 mothers (1,037 and 920 in the intervention and control arms, respectively) were retrieved for outcome measurements after 1 year of being registered. This study estimated the effectiveness of the depression intervention through cluster adjusted differences in the change in PHQ-9 scores between the baseline and the endpoint measurements for the intervention and control arms. Implementation was evaluated through emerging themes and codes from the framework analysis of 18 in-depth interview transcriptions of intervention participants. RESULTS: Intervention mothers had a 3.06-point (95% CI: −3.46 to −2.67) reduction in their PHQ-9 score at the endpoint compared with their control counterparts. The process evaluation revealed that the integration of structured depression care was feasible at primary clinics in poor urban settings. It also revealed gaps in the public–private care linkage system and the need to improve referral systems. CONCLUSIONS: Intervening for depression care at primary care clinics can be effective in reducing maternal depression. Clinic assistants can be trained to identify and deliver key depression counseling messages. The study invites policymakers to seize an opportunity to implement a monitoring mechanism toward standard mental health care.
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spelling pubmed-101179802023-04-21 Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis Owais, Syeda Somyyah Horner, Ronnie D. Khan, Muhammad Amir Kenison, Kelli Probst, Janice C. Front Glob Womens Health Global Women's Health INTRODUCTION: The prevalence of depression among women in Pakistan ranges from 28% to 66%. There is a lack of structured mental healthcare provision at private primary care clinics in low-income urban settings in Pakistan. This study investigated the effectiveness and processes of a facility-based maternal depression intervention at private primary care clinics in low-income settings. MATERIALS AND METHODS: A mixed-methods study was conducted using secondary data from the intervention. Mothers were assessed for depression using the Patient Health Questionnaire-9 (PHQ-9). A total of 1,957 mothers (1,037 and 920 in the intervention and control arms, respectively) were retrieved for outcome measurements after 1 year of being registered. This study estimated the effectiveness of the depression intervention through cluster adjusted differences in the change in PHQ-9 scores between the baseline and the endpoint measurements for the intervention and control arms. Implementation was evaluated through emerging themes and codes from the framework analysis of 18 in-depth interview transcriptions of intervention participants. RESULTS: Intervention mothers had a 3.06-point (95% CI: −3.46 to −2.67) reduction in their PHQ-9 score at the endpoint compared with their control counterparts. The process evaluation revealed that the integration of structured depression care was feasible at primary clinics in poor urban settings. It also revealed gaps in the public–private care linkage system and the need to improve referral systems. CONCLUSIONS: Intervening for depression care at primary care clinics can be effective in reducing maternal depression. Clinic assistants can be trained to identify and deliver key depression counseling messages. The study invites policymakers to seize an opportunity to implement a monitoring mechanism toward standard mental health care. Frontiers Media S.A. 2023-04-06 /pmc/articles/PMC10117980/ /pubmed/37091298 http://dx.doi.org/10.3389/fgwh.2023.1091485 Text en © 2023 Owais, Horner, Khan, Kenison and Probst. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Global Women's Health
Owais, Syeda Somyyah
Horner, Ronnie D.
Khan, Muhammad Amir
Kenison, Kelli
Probst, Janice C.
Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis
title Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis
title_full Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis
title_fullStr Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis
title_full_unstemmed Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis
title_short Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis
title_sort integrating maternal depression care at primary private clinics in low-income settings in pakistan: a secondary analysis
topic Global Women's Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10117980/
https://www.ncbi.nlm.nih.gov/pubmed/37091298
http://dx.doi.org/10.3389/fgwh.2023.1091485
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