Improving maternal mental health in South East Asia through assets based approaches.

围产期精神疾病(主要是怀孕期间和分娩后第一年的抑郁和焦虑)是一个主要的全球健康问题。如果没有正确的支持和治疗，它可能会对母亲和孩子的健康和福祉产生长期的负面影响。严重精神疾病是产妇在分娩后第一年死亡的主要原因之一，围产期精神疾病可能对婴儿的身体(低出生体重婴儿、母乳喂养减少、严重营养不良和生长受阻)、行为和社会发展产生负面影响，有可能造成跨代心理和身体健康不良的循环。围产期精神疾病对本已脆弱的妇女的影响不成比例，例如遭受暴力、社会支持不足和低收入的妇女。尽管关于LMIC的高质量信息有限，但它表明LMIC围产期精神疾病的发生率可能是高收入国家的三倍。因此，对围产期精神疾病进行有效和早期的治疗对低收入家庭的长期福利和福祉至关重要。东南亚的国家在种族、语言、文化和经济地位方面差异很大，有几个国家被归类为中低收入和最低收入类别。在该地区，人们对围产期精神疾病了解甚少，在社会和文化上可能被认为是不可接受的，受影响的妇女和家庭遭受耻辱和指责。此外，在获得熟练的精神卫生保健专业人员方面存在不平等，并且缺乏适合围产期精神健康的护理指导。这意味着围产期精神疾病在很大程度上没有得到充分的认识和治疗。我们已经建立了东南亚围产期精神健康研究网络(SEAPMHRN)(目前包括来自马来西亚、缅甸、印度尼西亚和泰国的成员)，其中包括研究人员、临床医生和该地区的卫生部，以制定围产期精神健康的长期研究计划。该网络已经举办了为期两天的讲习班(吉隆坡，2019年7月)，以确定LMIC国家参与者确定的研究范围和优先事项。我们的目标是进一步扩大和发展这一网络，将多学科专家(包括非政府组织和社区工作者)和普通人/妇女聚集在一起，制定与背景相关的研究议程，以了解和改善围产期心理健康。研究优先研讨会的参与者确定了三个关键领域需要解决：了解妇女在围产期精神健康问题上的经历和护理偏好；改进筛查和检测；解决专业人员和公众(围产期)精神健康素养低的问题。这项提议是为了资助以下相关活动：1.支持进一步的联网会议，鼓励扩大现有网络，包括与政策制定者、非政府组织、患者和公众参与和社区发展组织的更多联系，并继续制定研究优先事项；建立适当的沟通结构，如网站和交流访问；支持建设当地研究能力的赠款撰写小组。2.为确定的三个优先领域中的每一个领域开展基础研究：测试以数字方式获取参与国妇女的各种经历或围产期精神疾病的方法；对现有翻译后的筛查工具在东南亚妇女中发现围产期精神健康问题的有效性进行文献审查；评估和调整(如有可能)该区域今后提供围产期精神健康意识培训的现有资源。

Perinatal mental illness (mainly depression and anxiety during pregnancy and the first year after childbirth) is a major global health problem. Without the right kind of support and treatment, it can have long-term negative effects on the mother's and the child's health and wellbeing. Severe mental illness is one of the main causes of maternal deaths in the first year after childbirth and perinatal mental illness can negatively impact both the physical (low birth weight babies, reduced breast feeding, severe malnutrition and hampered growth), behavioural and social development of the infant, potentially creating a trans-generational cycle of poor mental and physical health. Perinatal mental illness disproportionately affects women who are already vulnerable, for example women exposed to violence, poor social support and low income. Although high quality information on LMICs is limited, it suggests that the occurrence of perinatal mental illness in LMIC may be three times higher than in high income countries. Therefore, effective and early treatment of perinatal mental illness is essential for the long-term welfare and wellbeing of populations in LMICs. South East Asia comprises countries that are highly diverse in terms of ethnicity, language and culture and economic status, with several countries categorised as lower-middle and lowest income categories. In this region, perinatal mental illness is poorly understood and may be considered socially and culturally unacceptable with affected women and families experiencing stigma and blame. Further, there is inequity of access to skilled mental healthcare professionals, and lack of care guidance appropriate to perinatal mental health. This means that perinatal mental ill health is largely under recognised and under treated. We have established a South East Asian Perinatal Mental Health Research Network (SEAPMHRN) (currently involving members from Malaysia, Myanmar, Indonesia and Thailand) which includes researchers, clinicians, and a health Ministry in the region to develop a long-term research programme in perinatal mental health. This network has already conducted a 2-day workshop (Kuala Lumpur July 2019) to scope and establish research priorities as defined by the LMIC country participants. We aim to further expand and develop this network, bringing together multi-disciplinary experts (including NGOs and community workers) and lay people/women, to develop a context relevant research agenda for understanding and improving perinatal mental health. The research prioritisation workshop participants identified 3 key areas to address: understanding women's experiences of perinatal mental health problems, and preferences for care; improving screening and detection; and addressing the problem of low (perinatal) mental health literacy among professionals, and the public.This proposal is for funding to cover the following related activities: 1. To support further networking meetings, encouraging expansion of the current network to include more links to policy makers, NGOs, patient and public involvement and community development organisations, and the continuing development of research priorities; setting up appropriate communication structures e.g. website and exchange visits; supporting grant writing groups which build local research capacity. 2. Conduct foundation research for each of the 3 priority areas identified: To test the methods for digitally capturing a range of women's experiences or perinatal mental illness from across participating countries; to conduct a literature review on the validity of existing translated screening tools for detecting perinatal mental health problems in SE Asian women; to assess and adapt (if possible) existing resources for future delivery of perinatal mental health awareness training in the region.