Integrating Mental Health into Community-Based Maternal Health Services

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PROJECT SUMMARY Aims: The goal of this study is to collect formative data to inform the development of a locally, culturally relevant module to integrate mental health prevention and promotion into maternal health services accessed by perinatal women in rural Mali, West Africa. Specifically, the study aims to: 1) qualitatively identify local mental health constructs; 2) examine local priorities and sources of care for mental health; and 3) review the literature of intervention content and delivery mechanisms for common perinatal mental disorders (CPMDs) in low and middle-income countries (LMIC). Significance: The perinatal period is defined as the antenatal period to one year postpartum. CPMDs are highly prevalent in LMICs, and have been shown to place children at increased risk for poorer physical and mental health outcomes. Limited research has been conducted to develop and evaluate prevention interventions for CPMDs within the context of antenatal care. In Mali, there is no official mental health policy, and mental health care services and providers are extremely limited. This research addresses Grand Challenges in Global Mental Health Goals, B, C, D, and E, and advances NIMH Strategic Aim 4 by developing innovative service delivery models to improve mental health. Approach: This study is embedded within a current NIH-Fogarty International Center (FIC) funded R21 project in Selingué, Mali (09/14- 08/16; a 12-month no cost extension will be requested). This study is informed by Patel’s model of the credibility gap, and the ethnomedical theory. Qualitative research methods are systematic and rigorous, particularly when measures do not exist, and will be utilized to gain in-depth understanding of mental health concepts. Aims 1-2 will be addressed with qualitative methods, including multiple interview techniques among perinatal women, non-specialist health workers (NSHWs), and mental health providers to identify local constructs and priorities for care, as well as observations of NSHWs home visits. Aim 1 will be analyzed using cultural salience analysis, the standard analytic technique for measuring shared beliefs as culture. Data from Aim 2 will be analyzed using ranked ordered logistic regression of priorities for care and thematic analysis. Aim 3 will be addressed through a literature review of intervention content and delivery mechanisms for CPMDs. Sources will include peer-reviewed literature and online manuals and toolkits in the field of maternal mental health. Fellowship Information: This study is the doctoral dissertation for Ms. Lasater, a current PhD student in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Ms. Lasater has chosen one primary sponsor, and four co-sponsors who have complementary expertise in the methods and topics of this project. The training plan is designed with mentorship, research, and intensive coursework to allow Ms. Lasater to develop expertise in qualitative research methods, and strong quantitative competencies to help her achieve her long-term goal of becoming a leading independent researcher in global mental health in sub-Saharan Africa.