Early-stage development of a complex, community-based intervention to improve women's perinatal health in rural communities in India

围产期心理健康是全球公共卫生的优先事项。据估计，五分之一的妇女在围产期（怀孕到出生后一年）有心理健康问题，低收入和中等收入国家的妇女的这一比例甚至更高。在印度，14-31%的妇女经历焦虑，抑郁，压力或自杀意念（常见的围产期精神障碍; CPMD）。在印度农村，妇女还受到CPMD的社会决定因素和交叉问题的影响，如性别不平等，贫困，家庭暴力，种姓和耻辱。然而，大多数患有CPMD的妇女没有得到护理，关于如何在资源匮乏的农村环境中最好地解决CPMD的研究很少。在中低收入国家，将心理健康纳入孕产妇保健服务往往被认为是不可行的，因为这些国家的卫生系统负担过重，资源不足。将精神卫生保健的任务从专业卫生工作者转移到同行工作者，有很好的证据和未充分利用的潜力来支持中低收入国家薄弱的卫生系统。围产期心理健康项目旨在制定干预措施，通过将心理健康纳入孕产妇保健，应对印度农村地区预防、发现和支持患有CPMD的妇女的重大挑战。我们的目标是为未来的发展、实施和评估制定一个明确的变革理论和途径。

Perinatal mental health is a global public health priority. It is estimated that 1 in 5 women has a mental health problem during the perinatal phase (pregnancy to one year after birth), and the rates are even higher for women in low- and middle-income countries (LMICs). In India, between 14-31% of women experience anxiety, depression, stress, or suicidal ideation (common perinatal mental disorders; CPMDs). In rural India, women are also affected by social determinants of CPMDs and intersecting issues, such as gender inequity, poverty, domestic violence, caste, and stigma. Yet, most women with CPMDs do not receive care, with little research exists on how to best address CPMDs in low resource, rural settings. Integration of mental health into maternal health services is often not thought feasible in LMICs, where health systems are overburdened and under-resourced. Task-shifting of mental health care from specialist health workers to peer workers has good evidence and underused potential to support weak health systems in LMICs. The Perinatal Mental Health project (PRAMH) aims to develop an intervention to address the significant challenge of preventing, detecting and supporting women with CPMDs in rural India, by integrating mental health into maternity care. Our aim is to develop a clear theory of change and pathway for future development, implementation, and evaluation.