Project Lead(s): Patricia Garcia
In developing countries, 50% of pregnant women have symptoms of depression and 15–20% suffer a major depressive disorder, which is associated with poor maternal and child indicators (such as prematurity, low birth weight, growth and developmental delay) as well as suicide.
In low- and middle-income countries, a shortage of psychologists and psychiatrists means many women with gestational depression are not assessed, diagnosed or adequately treated at the primary care level.
The project tested a new system of care for gestational depression patients called KusiyRed at a primary healthcare facility in Peru.
In this multidisciplinary approach, an obstetrician makes the diagnosis during the first prenatal visit, the psychologist initiates early treatment and the physician administers timely drug therapy.
The PHQ-9 and PHQ-2 components of the longer Patient Health Questionnaire were used by the obstetrician as concise, self-administered tools for assessing depression.
A system of sending text messages (SMS) to phones of pregnant women with information to inform them of the treatment offered in health centres was implemented. This also included appointment reminders and motivational messages.
Training in behavioural management was provided to psychologists, and doctors received training in drug treatment for depression. Patients who were assessed to be a suicide risk during initial assessment were referred to a psychologist the same day, as were those whose scores were indicative of moderate or severe depression.
The records of 200 women involved in the program were reviewed.
The percentage of pregnant women screened for depression during the first prenatal visit was 86% (versus a pre-implementation rate of 50%).
All pregnant women with depressive symptoms were referred to a psychologist for treatment and 85% of pregnant women with depression received SMS. Such support did not exist prior to initiation of the project.
An evaluation showed 100% of midwives considered this system to be very important to the screening of depression in pregnant women during their first antenatal control.
Seventy-one percent of healthcare professionals surveyed were satisfied with the KusiyRed program and believed it not only improved screening for depression in pregnant women, but also improved coordination with other services.
The team intends to apply for Transition To Scale (TTS) funding.