School of Health Sciences
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Item A COLLABORATIVE CARE MODEL FOR PERINATAL MENTAL HEALTH CARE IN SIERRA LEONE(Queen Margaret University, Edinburgh, 2023-12-13) Bah, Abdulai JawoThis study explored idioms of distress and explanatory models for perinatal psychological distress, developed a reliable and validated screening tool, and culturally adapted a problem-solving and behavioural activation intervention. Based on the proposition of the biopsychosocial vulnerability distress and outcome model, I applied mixed methods research in three phases of the study to (1) understand how pregnant women and new mothers experience and express perinatal psychological distress, their coping strategies, and their help-seeking behaviour (2) develop and validate a ten-item screening tool for perinatal psychological distress and use it to assess the prevalence of and risk factors for perinatal psychological distress, and (3) culturally adapt a problem solving and behavioural activation intervention for these pregnant women and new mothers. The ethnographic phase showed women use their hearts and (heads, minds, and brains) to express their emotions and thoughts, respectively. Thinking too much and stress were the most frequently mentioned symptoms. Their distress was related to marital or partner disharmony, gender norms, problems with in-laws, poverty, ill health, and a lack of basic amenities. They consulted religious leaders, herbalists, friends, neighbours, and family members for help for the most part. Their coping strategies included prayers, sleeping, listening to music, and sometimes alcohol to forget about their problems. During the tool development phase, we developed a ten-item tool and established a cut-off point at eight using an emic-etic approach. In the survey phase, we recruited 420 participants and measured antenatal and postnatal psychological distress prevalence of 208 (55.3%) and 212 (64.2%), respectively. Hunger, insult or rude treatment from nurses during antenatal care, ill health, and hostile in-laws were found to be independent predictors of antenatal psychological distress. Furthermore, postnatal psychological distress was independently predicted by having an unfaithful partner, inter-partner violence, ill health, and hunger. However, an income-generating activity was found to be protective for both pregnant women and new mothers. During the intervention phase, using a mixed method approach, 39 perinatal women (control = 19, intervention = 20) were randomly allocated at the community level to culturally adapted problem solving and behavioural activation interventions and a control group. The effectiveness, feasibility, and acceptability of these interventions were explored. Primary outcomes included were psychological distress and functional capacity, which were assessed at baseline, after two weeks, and at the end of the 4-week period. The results showed a reduction in symptoms with a moderate effect size (Cohen’s d = 0.40) and an increased function with regards to their daily tasks. The intervention was deemed feasible and acceptable by the laywomen in the community that delivered the intervention as well as the pregnant women and new mothers. The study identified idioms of distress and explanatory models that can be used to improve communication during clinical encounters between perinatal women and healthcare workers, which will decrease stigma and increase engagement with services. The newly developed tool can be used to screen perinatal women into services and assess their response to these services over time. The study also showed that PST is likely to be feasible, acceptable and effective. There is a need to do further studies using a fully powered randomised control trial to demonstrate effectiveness and to understand how this intervention can be integrated into the primary health care and scaled up nationwide.