Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa

Honikman, Simone; van Heyningen, Thandi; Field, Sally; Baron, Emily; Tomlinson, Mark

Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa

Journal Article

2012

Journal Title

PLOS Medicince

Link to Journal

http://journals.plos.org/plosmedicine

Publisher

Public Library of Science

Publisher

University of Cape Town

Department

Centre for Public Mental Health

Faculty

Faculty of Health Sciences

License

http://creativecommons.org/licenses/by/4.0

Abstract

Common mental disorders such as anxiety and depression are the third leading causes of disease burden globally for women between 14 and 44 years of age [1]. By 2030, these are expected to rise to first place, ranked above heart disease and road traffic injuries [2]. A recent systematic review reveals that maternal mental disorders are approximately three times more prevalent in low- and middle-income countries (LMICs) than in high-income countries (HICs), where the related burden of disease estimates range between 5.2% and 32.9% [3],4. In HICs, maternal suicide is the leading cause of death during the perinatal period, and while there is a relative dearth of information about maternal suicide in LMICs, the estimates are similarly high [5],[6]. Untreated maternal mental illness affects infant and child growth [7] and the quality of child care [8], resulting in compromised child development [4],[9]. Community-based epidemiological studies in South Africa have shown high prevalence rates of depressed mood amongst pregnant and postnatal women. In a low-income, informal settlement outside of Cape Town, 39% of pregnant women screened positive on the Edinburgh Postnatal Depression Scale (EPDS) for depressed mood [10] and 34.7% of postnatal women were diagnosed with depression [11]. In a rural area of KwaZulu-Natal province with high HIV prevalence, 47% of women were diagnosed with depression in their third trimester of pregnancy [12].