How to Treat Maternal Depression in Rural Ghana
This post is part of “Mental Health: The Missing Piece in Maternal Health,” a blog series co-hosted by the MHTF, the Mental Health Innovation Network at the London School of Hygiene and Tropical Medicine and Dr. Jane Fisher of Monash University.
Until recently, the health system in Ghana had been quite silent on maternal depression, which had a number of consequences on maternal and newborn outcomes. To address this need, The National Catholic Health Service, with funds from Grand Challenge Canada, rolled out a quality improvement project to reduce the treatment gap for perinatal depression in seven facilities in four regions in Ghana to improve early identification and treatment of maternally depressed women.
A very moody and ill-looking Madam Afi*, was identified with a moderately severe case of maternal depression—with a score of 19 using the PHQ-9 screening tool—when she visited antenatal clinic at Catholic Hospital, Battor, one of the quality improvement project facilities. Madam Afi was 16 weeks pregnant when her midwife screened her for maternal depression during focused antenatal clinic. During the screening, Madam Afi told her midwife that she lost her father four weeks prior and soon after her husband also got very sick and was admitted at the hospital. Heavily reliant on her husband for emotional support while mourning and financial support for the family’s daily activities, these events broke her down and contributed to her lack of sleep, poor appetite, little interest in doing things and loss of the meaning to life.
Once identified as depressed, Madam Afi was counseled and the mental health team followed up with her using weekly phone calls and home visits. She also visited the mental health unit (now branded ‘PEACE Clinic’ to reduce the stigma previously attached to the unit) whenever she visits the hospital for antenatal care. During her counseling sessions, she was given advice on how to manage these unfortunate incidents happening in her life.
A mental health nurse was assigned to her to give her some emotional support, such as accompanying her to visit her husband and to the district social welfare department where she was referred for social and financial assistance. Madam Afi attained a full clinical response, with a PHQ-9 score of 0 six weeks after identification. Also, her husband has recovered and has been discharged from the hospital. Today Madam Afi looks and feels better and she is anxiously waiting to welcome her baby in about four week’s time.
The effects of maternal depression are numerous. Before this project, mothers suffering from mild depression would visit the antenatal unit unnoticed and just before delivery or after delivery become psychotic potentially leaving the mother, child and the family debilitated. These women are more often than not discriminated against and branded as being evil. Now the Battor community and pregnant women visiting the hospital have been educated on maternal depression and the need for early identification and care seeking. Midwives and mental health staff in the facility are elated with the positive effect of the project on the wellbeing of their clients. They also believe that this project will improve the patient-provider relationship and, in the long term, improve the quality of life of their clients.
*name has been changed to protect patient privacy
Enjoyed this post about maternal mental health? Read more posts in the Mental Health: The Missing Piece in Maternal Health blog series.
Photo: “Laughing” © 2008 Adam Cohn, used under a Creative Commons Attribution license: http://creativecommons.org/licenses/by/2.0/