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      Feasibility and acceptability of a community health worker administered behavioral activation intervention for postpartum depression: a single arm pilot study from India

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          Abstract

          Introduction

          Women in India experience high rates of postpartum depression (PPD), with minimal availability of screening or treatment. India has an extensive network of community health workers, known as accredited social health activists (ASHAs). While they are knowledgeable about most maternal–child health problems, they have minimal knowledge about PPD. We trained ASHAs to deliver a simple home-based intervention, behavioral activation (BA), which involves individuals in activities that are sources of positive reinforcement to counter depression. The research questions guiding this study were as follows: 1) What are the feasibility and acceptability of ASHAs screening for and delivering a brief behavioral activation intervention addressing PPD among women in Belagavi, South India? 2) What impact did the brief behavioral activation intervention have on PPD?

          Methods

          The mixed methods evaluation used interviews with participants and interventionists, and depression scores were assessed before and after the evaluation. After a 2-day training with 17 ASHAs that focused on understanding PPD, screening using the Edinburgh Postnatal Depression Scale (EPDS), and implementing the BA protocol, ASHAs and researcher supervisors screened the mothers 6–12 weeks postpartum presenting at pediatric immunization clinics. Mothers who screened positive were invited to participate in an ASHA-led 5-week BA intervention, with ASHAs visiting the mothers’ homes. We assessed post-intervention EPDS scores and conducted satisfaction assessments and individual interviews.

          Results

          All 26 women who screened positive on the EPDS agreed to be enrolled in the study. All participants had a significant reduction (p < 0.001) in PPD scores. Both ASHAs and mothers had high enthusiasm for the intervention methods and activities.

          Discussion

          This ASHA-delivered BA intervention was found to be feasible, acceptable, and effective in treating PPD in rural Indian mothers. This corroborates literature that demonstrates the efficacy of a BA intervention among individuals with generalized depression in South Asia. In communities with minimal mental health resources, interventions led by trained community workers have the potential to address PPD.

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          Most cited references23

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          Naturalistic inquiry

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            Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

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              Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes

              Introduction: The postpartum period represents the time of risk for the emergence of maternal postpartum depression. There are no systematic reviews of the overall maternal outcomes of maternal postpartum depression. The aim of this study was to evaluate both the infant and the maternal consequences of untreated maternal postpartum depression. Methods: We searched for studies published between 1 January 2005 and 17 August 2016, using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane Pregnancy and Childbirth Group trials registry. Results: A total of 122 studies (out of 3712 references retrieved from bibliographic databases) were included in this systematic review. The results of the studies were synthetized into three categories: (a) the maternal consequences of postpartum depression, including physical health, psychological health, relationship, and risky behaviors; (b) the infant consequences of postpartum depression, including anthropometry, physical health, sleep, and motor, cognitive, language, emotional, social, and behavioral development; and (c) mother–child interactions, including bonding, breastfeeding, and the maternal role. Discussion: The results suggest that postpartum depression creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. It therefore seems important to detect and treat depression during the postnatal period as early as possible to avoid harmful consequences.
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                Author and article information

                Contributors
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                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                29 April 2024
                2024
                : 15
                : 1284674
                Affiliations
                [1] 1 College of Nursing, Thomas Jefferson University , Philadelphia, PA, United States
                [2] 2 Jawaharlal Nehru Medical College , Belgaum, Karnataka, India
                [3] 3 College of Nursing, KLE University , Belgaum, Karnataka, India
                [4] 4 College of Applied Medical Sciences Department of Nursing University of Bisha , Bisha, Saudi Arabia
                Author notes

                Edited by: Sami Hamdan, Academic College Tel Aviv-Yaffo, Israel

                Reviewed by: Ashlesha Bagadia, The Green Oak Initiative, India

                Yogender Malik, Pandit Bhagwat Dayal Sharma University of Health Sciences, India

                Nicole Votruba, University of Oxford, United Kingdom

                *Correspondence: Amy Szajna, Amy.szajna@ 123456jefferson.edu
                Article
                10.3389/fpsyt.2024.1284674
                11089130
                38742133
                cad2c41b-3777-4e92-9203-05b6df231e8d
                Copyright © 2024 Szajna, Tekkalaki, Nandagaon, Udapi, Sogalad, Dandagi, Kole, Patil, Raddi, Short and Kelly

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 28 August 2023
                : 12 March 2024
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 26, Pages: 6, Words: 3147
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Stratton Foundation Grant awarded through Thomas Jefferson University School of Nursing.
                Categories
                Psychiatry
                Original Research
                Custom metadata
                Perinatal Psychiatry

                Clinical Psychology & Psychiatry
                postpartum depression,south india,behavioral activation,community-health worker,maternal mental health

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