Guidelines to manage perinatal depression in Namibia

Abstract

Background: Perinatal depression is a serious mental health disorder and public health concern, which can have disabling effects among women during the perinatal period. Perinatal depressive disorders contribute to between 5% and 20% of the disease burden of women during the perinatal period globally, and 11.9% of women suffering from perinatal depression are from low- and middle-income countries, including Namibia. Perinatal mental health guidelines are still lacking in the majority of low- and middle-income countries. Although Namibia has perinatal guidelines, the guidelines do not include perinatal mental health. This study was conducted in Windhoek, which is the capital city of Namibia and is situated in the Khomas region, one of the 14 regions in the country. Aim: The study aimed to develop guidelines to manage perinatal depression in Namibia. The developed guidelines may provide a systematic and uniform method for early detection and management of perinatal depression. Design: The researcher used a multi-method research design, the constructivist paradigm, and Kinser and Lyon’s (2014) conceptual framework of stress vulnerability, depression, and health outcomes in the study. Methods: The study was conducted in three phases. Phase 1 explored and described the experiences and the needs of women with perinatal depression. Explored and described the healthcare providers’ experiences of working with women with perinatal depression and its management. Data was collected by means of semi-structured interviews, using an interview guide based on the study objectives and informed by the conceptual framework. Phase 2 focused on a systematic literature review of guidelines used to manage perinatal depression globally. The researcher selected the Centre of Perinatal Excellence (COPE) 2017 Effective mental health care in the perinatal period: Australian clinical practice guidelines for adaptation to the Namibian context. The guidelines were developed to accommodate the Aboriginal and Torres Strait Islander women in Australia, who often confronted mental health problems, cultural disconnect, and multiple stressors in the form of poverty or poor housing, child removal, trauma, abuse, and loss. The researcher believed that the context of this population had similar characteristics with most low- and middle-income countries, including Namibia. Phase 3 involved drafting, refining, and reaching consensus on the guidelines to manage perinatal depression in Namibia. The researcher based the guidelines on the findings of Phases 1 and 2 and followed the steps of AGREE II: Advancing guideline development, reporting and evaluation in health care. The guidelines were refined by a panel of experts in a nominal group technique according to seven criteria, namely scope, purpose, stakeholder involvement, validity, reliability, clarity and applicability. Based on the comments and recommendations of the expert panel, the researcher reformulated the guidelines to manage perinatal depression, and consensus was reached.

Conclusion: The findings revealed the needs of women with perinatal depression, namely support needs and health care needs. Support needs included social needs and health care support. Health care needs included creating awareness about perinatal depression, sensitizing the community and family members, screening for perinatal depression, and a need for privacy, confidentiality and follow-up visits. The women used spiritual practices, distraction, self-reliance and resilience, and social and emotional support as methods to cope with perinatal depression. The healthcare providers revealed that the following barriers prevented them from assessing and managing perinatal depression: difficulty recognizing signs and symptoms of perinatal depression, lack of guidelines and health service approach to maternal mental health, cultural influences and, lack of community awareness, and a shortage of healthcare providers. The researcher integrated the findings to develop guidelines to manage perinatal depression to benefit women with perinatal depression in Namibia.