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Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka

Early identification of mental health problems in pregnancy in low-income and middle-income countries is scarcely reported. We present the experience of a programme assimilating screening and management of antenatal anxiety and depression in conjunction with the Rajarata Pregnancy Cohort, in Sri Lan...

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Autores principales: Agampodi, Thilini, Amarasinghe, Gayani, Wickramasinghe, Anuprabha, Wickramasinghe, Nuwan, Warnasekara, Janith, Jayasinghe, Imasha, Hettiarachchi, Ayesh, Nimesha, Dilshi, Dilshani, Thivanka, Senadheera, Subhashinie, Agampodi, Suneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533714/
https://www.ncbi.nlm.nih.gov/pubmed/37748792
http://dx.doi.org/10.1136/bmjgh-2023-012852
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author Agampodi, Thilini
Amarasinghe, Gayani
Wickramasinghe, Anuprabha
Wickramasinghe, Nuwan
Warnasekara, Janith
Jayasinghe, Imasha
Hettiarachchi, Ayesh
Nimesha, Dilshi
Dilshani, Thivanka
Senadheera, Subhashinie
Agampodi, Suneth
author_facet Agampodi, Thilini
Amarasinghe, Gayani
Wickramasinghe, Anuprabha
Wickramasinghe, Nuwan
Warnasekara, Janith
Jayasinghe, Imasha
Hettiarachchi, Ayesh
Nimesha, Dilshi
Dilshani, Thivanka
Senadheera, Subhashinie
Agampodi, Suneth
author_sort Agampodi, Thilini
collection PubMed
description Early identification of mental health problems in pregnancy in low-income and middle-income countries is scarcely reported. We present the experience of a programme assimilating screening and management of antenatal anxiety and depression in conjunction with the Rajarata Pregnancy Cohort, in Sri Lanka. We adopted a two-stage screening approach to identify the symptoms and the reasons for anxiety and depression. Pregnant women (n=3074), less than 13 weeks of period of gestation underwent screening with the Edinburgh Postnatal Depression Scale (EPDS). Scores were positive among 23% and 14% of women in the first and second trimesters, respectively. Clinical (telephone) interviews (n=78, response 56.9%) were held for women having high EPDS scores to screen for clinical depression using the ‘mental health GAP’ tool. Targeted interventions including counselling, financial and social support and health education were employed. The procedure was repeated in the second trimester with in-person clinical interviews and inquiry into intentional self-harm. Our findings indicated that (1) the majority of mental health problems in early pregnancy were anxiety related to early pregnancy-associated conditions manageable at the primary healthcare level, (2) coupling mental health screening using psychometric tools with clinical interviews facilitates targeted patient-centred care, (3) the majority of intentional self-harm during pregnancy is not in the routine health surveillance system and (4) promoting women to attend the psychiatry clinic in tertiary care hospital has been difficult. Following the experience, we propose a model for mental health service provision in routine pregnancy care programme starting from early pregnancy.
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spelling pubmed-105337142023-09-29 Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka Agampodi, Thilini Amarasinghe, Gayani Wickramasinghe, Anuprabha Wickramasinghe, Nuwan Warnasekara, Janith Jayasinghe, Imasha Hettiarachchi, Ayesh Nimesha, Dilshi Dilshani, Thivanka Senadheera, Subhashinie Agampodi, Suneth BMJ Glob Health Practice Early identification of mental health problems in pregnancy in low-income and middle-income countries is scarcely reported. We present the experience of a programme assimilating screening and management of antenatal anxiety and depression in conjunction with the Rajarata Pregnancy Cohort, in Sri Lanka. We adopted a two-stage screening approach to identify the symptoms and the reasons for anxiety and depression. Pregnant women (n=3074), less than 13 weeks of period of gestation underwent screening with the Edinburgh Postnatal Depression Scale (EPDS). Scores were positive among 23% and 14% of women in the first and second trimesters, respectively. Clinical (telephone) interviews (n=78, response 56.9%) were held for women having high EPDS scores to screen for clinical depression using the ‘mental health GAP’ tool. Targeted interventions including counselling, financial and social support and health education were employed. The procedure was repeated in the second trimester with in-person clinical interviews and inquiry into intentional self-harm. Our findings indicated that (1) the majority of mental health problems in early pregnancy were anxiety related to early pregnancy-associated conditions manageable at the primary healthcare level, (2) coupling mental health screening using psychometric tools with clinical interviews facilitates targeted patient-centred care, (3) the majority of intentional self-harm during pregnancy is not in the routine health surveillance system and (4) promoting women to attend the psychiatry clinic in tertiary care hospital has been difficult. Following the experience, we propose a model for mental health service provision in routine pregnancy care programme starting from early pregnancy. BMJ Publishing Group 2023-09-25 /pmc/articles/PMC10533714/ /pubmed/37748792 http://dx.doi.org/10.1136/bmjgh-2023-012852 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Practice
Agampodi, Thilini
Amarasinghe, Gayani
Wickramasinghe, Anuprabha
Wickramasinghe, Nuwan
Warnasekara, Janith
Jayasinghe, Imasha
Hettiarachchi, Ayesh
Nimesha, Dilshi
Dilshani, Thivanka
Senadheera, Subhashinie
Agampodi, Suneth
Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka
title Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka
title_full Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka
title_fullStr Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka
title_full_unstemmed Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka
title_short Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka
title_sort incorporating early pregnancy mental health screening and management into routine maternal care: experience from the rajarata pregnancy cohort (rapco), sri lanka
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533714/
https://www.ncbi.nlm.nih.gov/pubmed/37748792
http://dx.doi.org/10.1136/bmjgh-2023-012852
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