Research on antenatal depression and anxiety among pregnant women in Pakistan is scarce, despite depressive disorders being a major disease burden, particularly in low and middle income countries. Studies estimate the prevalence of depression amongst pregnant Pakistani women to range between 36% to 40%4, while anxiety among pregnant women has been found to be as high as 49%5.
There is also a large treatment gap in the country with a handful of institutions and professionals providing appropriate treatment. Rather than using specialised care settings to address mental disorders, integrated primary care settings optimise health worker interventions for mental health through ‘task-sharing’—delegating tasks and responsibilities from more specialised mental health clinicians to less specialised health workers.
In April 2018, Interactive Research and Development Pakistan integrated mental health services in eight primary care sites through the task-sharing approach within Indus Health Network’s Primary Care Program. Through support from Grand Challenges Canada’s Transition to Scale funding, they are working with three partner healthcare organizations to take this innovation to scale. All of these partners have a strong focus on maternal, neonatal, child health and nutrition within their primary care programs.
The primary aim of the program is to improve mental health outcomes of at least 3,121 patients, with 85% of beneficiaries being women. The improved outcome will be measured by comparison of pre and post intervention scores on PHQ-9 and GAD-7. The program also aims to improve the quality of life of people suffering from mental health issues as measured by baseline and endline comparisons on the Manchester Short Assessment of Quality of Life (MANSA) scale.
The innovation components to achieve it’s targets for capacity building, screening and enrolment are as follows:
- Training of Lay Counsellors – This is done using a Basic Counselling Skills Training Manual that was developed by IRD, with support from Grand Challenges Canada. It has been used to train over 100 lay counsellors.
- Screening for Common Mental Disorders, specifically Depression and Anxiety - All patients over the age of 15years are screened for symptoms of depression and anxiety using PHQ-4 as part of the primary care service cycle. Those symptomatic are further assessed PHQ-9 and GAD-7 by lay counsellors.
- First Line Counselling - Based on the assessment, patients are enrolled for 4 – 6 counselling sessions with the lay counsellor at the facility. The option of home and phone counselling is provided for patients unable to continue sessions at the facility.
- Referral - The program psychologist is the point of referral for lay counsellors for cases which need further evaluation. These include cases of suicide ideation, self-harm, or other symptoms of severe anxiety/depression. The psychologist evaluates the patient and continues therapy sessions with the patient or refers to a psychiatrist, subject to need.