JHSPH - Population, Family, and Reproductive Health
Uganda - Assessment of an innovative model for maternal mental health in post-conflict Uganda
Perinatal depression is a problem effecting approximately one in five women in post-conflict Uganda. These rates of depression are high due to a multitude of risk factors including unwanted or unplanned pregnancies, experiencing domestic violence, chronic sickness, poverty and absent or unsupportive husbands. It is not only important to address the problem of perinatal depression for the sake of the mother, but recent research has also shown a link between the mental health of a mother and the health and development of her offspring. Maternal depression is a known risk factor for a range of child-related outcomes, including preterm birth and low birth weight; suboptimal breastfeeding and immunization rates; being underweight or stunted; higher rates of diarrhea and febrile illness; and negative impacts on child development.
To address the high burden of perinatal depression in post-conflict Uganda, the Peter C. Alderman Foundation (PCAF), in collaboration with the government of Uganda and the department of Mental Health at JHSPH, has developed an innovative stepped-care model that attempts to integrate mental health screening and services into the existing maternal and child health care system. This stepped-care model starts with screening at antenatal care visits and utilizes community health care workers to deliver psycho-education, an evidence-based low-intensity intervention that has been shown effective in reducing depression symptoms in up to 75% of women. Then, only women who do not improve with psycho-education are referred to PCAF staff for group interpersonal therapy. This method of task-shifting attempts to provide services in a sustainable and effective way while reducing the burden on scarce and overworked primary health care workers and mental health specialists.
Following completed formative research, this care model has been rolled out in two districts of post-conflict Uganda: Soroti District in eastern Uganda and Kitgum District in northern Uganda. Both regions were chosen because they were targeted during the 20-year conflict with the Lordâ€™s Resistance Army (LRA). This enduring and tragic conflict is still strongly exerting its negative impacts on the community 10 years after the cessation of hostilities.
Global Health/PI Mentor: Wietse Tol