Addressing Perinatal Depression in Deprived Areas of Istanbul, Turkey

为什么在怀孕期间解决女性抑郁症很重要在世界范围内，怀孕期间的抑郁症影响大约四分之一的女性。土耳其的情况类似。这些妇女中的大多数没有得到任何治疗。未经治疗的抑郁症不仅对妇女造成巨大痛苦，而且影响母婴关系。它可能导致大脑发育受损，长期婴儿生长不良。及时治疗可以预防这些并发症。围产期抑郁症可以通过“谈话疗法”有效治疗。最有效的谈话疗法之一，健康思维计划，是由拉赫曼和他的团队在巴基斯坦开发的。该方案被世界卫生组织采纳为治疗围产期抑郁症的正式第一线方案。不过，该方案是为联系紧密的农村社区制定的，由社区保健工作者单独向农村妇女提供。在像伊斯坦布尔这样的大城市，农村地区的快速移民可能导致传统家庭和社区支持的崩溃，这可能会增加抑郁症的风险。在高收入国家，团体治疗已被证明是有效的，并以较低的成本交付。对于支助网络中断的社区来说，这些也可能非常有用。目前没有健康思维方案的团体版本。本项目的目标有两个方面：目标1。调整世卫组织完善的“健康思维方案”，使其能够提供给伊斯坦布尔城市贫困地区的妇女群体，并在该市贫困地区的选定产前医院测试该方案。目标2.建设马尔马拉大学研究人员的能力，使他们今后能够在这一重要但被忽视的公共卫生领域开展大规模研究。我们将如何实现我们的目标这项研究将在伊斯坦布尔的6家公立医院进行，这些医院服务于低社会经济水平的地区。这些医院定期为来自贫困家庭的妇女开办产前培训班。我们将把我们的干预措施纳入这些医院。目标1：分两个阶段实现。在形成阶段，我们将与所有关键利益相关者的团体进行交谈，包括妇女、她们的伴侣和提供干预措施的护士。我们将与当地专家和专家举行研讨会，以使干预措施适应集体交付的形式。在可行性阶段，我们将比较适应的“小组”健康思维方案（干预）与常规的学前班（对照）。这两种干预措施将提供给120名妇女，随机分为干预组和对照组。我们的目标是探索新的干预措施是否可行，是否为所有利益相关者所接受，培训和监督程序是否有效，并测试未来大规模研究所需的工具。我们将使用定性和定量的方法来探讨这些issues.Objective 2：通过我们以前在南亚的工作，我们已经开发了一个特殊的课程，以培训新的研究人员在设计和评估干预措施，为低收入和中等收入国家的心理健康。我们将举办两个讲习班，旨在培训马尔马拉大学的研究人员参加这一综合课程。课程内容包括在低收入和中等收入国家设计、实施、监测和评价干预措施。我们将如何使用我们的项目结果我们将与世界卫生组织密切合作，将我们的研究结果纳入修订后的“健康思维计划”的“小组”版本，该计划将通过世卫组织的旗舰精神卫生差距行动计划向所有成员国传播。我们在马尔马拉大学的合作伙伴处于理想的位置，可以将干预措施扩大到伊斯坦布尔的其他地区。我们将在期刊上发表论文并出席会议。

Why is it important to address depression in women during pregnancy Worldwide, depression during pregnancy affects about one in four women. The situation is similar in Turkey. The majority of these women do not receive any treatment. Untreated depression causes great suffering not only to the woman, but also affects the relationship between the mother and infant. It can lead to impaired brain development and poor growth in the infant in the long-term. Timely treatment can prevent these complications. Perinatal depression be treated effectively with 'talking therapies'. One of the most effective talking therapies, the Thinking Healthy Programme, was developed by Rahman and his team in Pakistan. The programme was adopted by the World Health Organization as its official first-line treatment for perinatal depression. However, the programme was developed for close-knit rural communities and delivered individually to rural women by community health workers. In big cities like Istanbul, rapid migration from rural areas can lead to breakdown of traditional family and community support which may increase the risk of depression. In High Income countries, group therapies have been shown to be effective and deliverable at lower cost. These may also be very useful for communities in which support networks are disrupted. There is currently no group version of the Thinking Healthy Programme. Objectives of the projectThe objectives of this project are two-fold:Objective 1. To adapt the well-established WHO Thinking Healthy Programme so it can be delivered to groups of women in deprived urban areas of Istanbul and to test the programme in selected antenatal hospitals in deprived districts of the city. Objective 2. To build capacity of researchers at Marmara University so they can undertake future large-scale studies in this important but neglected area of public health. How will we address our objectivesThe study will be conducted in 6 public hospitals serving low socioeconomic districts in Istanbul. These hospitals run regular antenatal classes for women from very poor backgrounds. We will integrate our intervention in these hospitals. Objective 1: This will be achieved in two phase. In the formative phase, we will talk to groups of all key stakeholders, including women, their partners and nurses who deliver the intervention. We will hold a workshop with local specialists and experts to adapt the intervention to the group-delivery format. In the feasibility phase, we will compare the adapted 'group' Thinking Healthy programme (intervention) with routine Antenatal classes (control). Both interventions will be delivered to 120 women, randomly divided into intervention and control groups. Our aim is to explore if the new intervention is feasible and acceptable to all our stakeholders, the training and supervision procedures work, and to test the tools required a future large-scale studies. We will use both qualitative and quantitative methods to explore these issues.Objective 2: Through our previous work in South Asia, we have developed a special course to train new researchers in designing and evaluating interventions for mental health in low and middle income countries. We will conduct two workshops aimed at training researchers at Marmara University in this comprehensive course. The content of the course includes design, implementation, monitoring and evaluation of interventions in low- and middle-income countries. How we will use the results of our projectWe will work closely with the World Health Organization to incorporate our findings into the revised 'group' version of the Thinking Healthy Programme which will be disseminated to all member countries through the WHO's flagship mental health gap action programme. Our partners at Marmara University are ideally placed to scale-up the intervention to other districts in Istanbul. We will publish papers in journals and present at conferences.