Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature

South African Journal of Psychiatry ISSN: (Online) 2078-6786, (Print) 1608-9685 Page 1 of 5 Original Research Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature Authors: James January1 Moses J. Chimbari2 Background: The perinatal period provides an opportune time for health care providers to screen for and proffer interventions for women suffering from depression. However, routine screening for depression is not done in primary care settings in Zimbabwe. Affiliations: 1 Department of Psychiatry, University of KwaZulu-Natal, South Africa Aim: This narrative review discusses opportunities and obstacles surrounding screening for perinatal depression in primary care settings in Zimbabwe, with a view to stress the importance of routine screening to policy-makers. School of Nursing and Public Health, University of KwaZulu-Natal, South Africa 2 Corresponding author: James January, Dates: Received: 29 Apr. 2017 Accepted: 11 July 2018 Published: 28 Aug. 2018 How to cite this article: January J, Chimbari MJ. Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature. S Afr J Psychiat. 2018;24(0), a1127. https://doi.org/10.4102/ sajpsychiatry.v24i0.1127 Copyright: © 2018. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. Read online: Scan this QR code with your smart phone or mobile device to read online. Methods: Both electronic and manual searches were done on PubMed, PubMed Central, African Journals Online, Google Scholar and the University of Zimbabwe Institutional Repository (UZIR) using the following key terms: ‘women and antenatal depression’, ‘prenatal depression’, ‘postnatal depression’, ‘postpartum depression’, ‘depressive disorder’, or ‘common mental disorder’ and ‘screening and Zimbabwe’. Results: Although opportunities for depression screening are possible because of the high antenatal and postnatal service coverage, the potential for universal screening is fraught with human and financial resource constraints, lack of training in mental health care among primary health care providers and lack of locally validated screening tools for depression. Conclusion: There is a need to channel resources into the training of midwives and other primary health care providers on mental health issues affecting women perinatally. Introduction Depression exerts a substantial burden on women during the perinatal period.1 In a recent systematic review, it was shown that antenatal depression may have short- and long-term negative effects on the foetus, newborns and adolescents.2 Evidence suggests that women with perinatal depression tend to have children who are undernourished,3 have adjustment difficulties,4 are stunted,5 are poorly fed, are less likely to be vaccinated and experience compromised safety practices.6 Alder and colleagues reported that pregnant women with elevated levels of depressive symptoms were more likely to experience obstetric complications and preterm labour.7 All these potential adverse outcomes warrant more concerted efforts to tackle this often neglected condition, especially in resource-poor settings. The Global Burden of Diseases Report of 2010 showed that major depressive disorders (MDD) were the second leading cause of years lived with disability (YLD) with a prevalence of 8.2%. The largest proportion of these depressive disorders occur between the ages of 15 and 64 years with women being the most affected.8 Women in low- and middle-income countries (LMICs) are disproportionately affected by depression with prevalence of postnatal depression (PND) as measured by screening studies using the Edinburgh Postnatal Depression Scales (EPDS), reaching up to 34% in Zimbabwe.9,10,11 In Zimbabwe, common mental disorders (CMDs) like depression and anxiety are prevalent among women.12 Recently, it was reported that 21.4%, 21.6% and 4% of respondents to a survey conducted in Harare had PND as measured by the Center for Epidemiological Studies-Depression Scale, postpartum suicidal ideation and suicidal attempts, respectively, during the perinatal period.13 Challenges, however, exist in estimating the true burden of perinatal depression. This is in part because of the fact that there is a paucity of studies using diagnostic criteria such as the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). Additionally, most studies in Zimbabwe on perinatal depression are carried out in urban settings and scant data exist for rural populations.11,14 http://www.sajpsychiatry.org Open Access Page 2 of 5 Studies that have been conducted in Zimbabwe have indicated that factors which increase the risk of PND include HIV, gender, socio-economic status and quality of life.14 In a study carried out in 2016 among 264 adults, people living with HIV were found to have a higher prevalence of possible CMDs (67.94%) and depression (68.5%) than those without HIV (CMDs – 51.4%; depression – 47.2%).15 Common mental disorders and depression were also associated with being female (72.6%) and experiencing negative life events like divorce, intimate partner violence and unemployment.15 Because of lack of free-standing mental health facilities in most parts of Zimbabwe, psychological services are often integrated into primary care. Antenatal and postnatal visits provide some of the most ideal opportunities for health care providers to recognise, screen for and possibly respond to women who may be having depressive symptoms, and thereby potentially enhance pregnancy outcomes. The recently completed Demographic and Health Survey for Zimbabwe indicated that nearly all (93%) women who had given birth in the 5-year period preceding the survey had received antenatal care (ANC) from a trained health care professional at least once.16 This presents an ideal opportunity to potentially screen women for depression during pregnancy. Additionally, a substantial percentage of women (76%) had had 4 or more ANC visits, which reflected a good increase from the 65% reported in the 2010–2011 survey. There were also no major differences in these percentages between urban and rural women. Benefits of screening for perinatal depression The United States of America Preventive Services Task Force recently concluded that depression screening programmes for pregnant and postnatal women may have a positive effect of reducing prevalence of depressive symptoms.1 If screening is followed by effective treatment, the burden of depression among women in the perinatal period can be significantly reduced. Thus, screening provides a window of opportunity to detect women requiring further diagnosis and treatment. Furthermore, screening may encourage women to open up and talk about their problems, resulting in less stigma surrounding depression. In light of the foregoing arguments, this review of (...truncated)