Study on awareness and management based health action using video intervention (SAMBHAV) for postpartum depression among mothers attending immunisation clinic in a tertiary medical college hospital: Study protocol.

INTRODUCTION: Pregnancy exerts a detrimental effect on women's mental health. Maternal mental health is considered as one of the public health concerns as it impacts the health of both mother and the child. One in five people in developing countries experience serious mental health issues during pregnancy and after giving birth. In India, postpartum depression (PPD) affects 22% of women, according to a research by WHO. The available data on mental health literacy among women, showed that only 50.7% of the postpartum mothers who were attending paediatric tertiary care centres had adequate knowledge about PPD. It is crucial to diagnose early and adequately manage postpartum depression to avoid long-term consequences. It is also essential to seek help and utilise the available resources and services to avoid worsening of the condition and to aid in the recovery. This demonstrates the need to promote awareness, improve help seeking, reduce stigma and treatment gap associated with PPD through educational video intervention specific to cultural context and beliefs. MATERIALS AND METHODS: This is a quasi-experimental study without a control group that attempts to improve the awareness among the mothers about postpartum depression to understand better about the condition and also its management through video intervention. The video intervention will be developed in regional language specific to the cultural context of the setting. The video script will be finalised from the findings of the available literature and also through focus group discussion among mothers and health care professionals which will be analysed qualitatively using thematic identification. The study will use a standardized Postpartum Depression Literacy Scale (PoDLIS) which will be quantitatively analysed using paired t test before and after the intervention. Repeated measures of ANOVA will also be used to analyse the changes in literacy scale scores with respect to socio demographic variables. The mothers will also be screened for PPD using Patient Health Questionnaire 9 (PHQ 9) and feedback will be collected and analysed to find the overall usefulness of video. DISCUSSION: If it becomes apparent that this video intervention is successful in raising awareness of PPD among postpartum mothers and reducing stigma, it can be used to aid early identification of mothers with PPD which can result in early management and improved health outcome for both mothers and children. The major goals of the video intervention are to raise awareness, lessen stigma, and prevent PPD through strong family support, adopting healthy lifestyles, having access to information, practising self-care, and enhancing help-seeking. TRIAL REGISTRATION: The trial is registered under the Clinical Trial Registry- India (CTRI) (CTRI/2023/03/050836). The current study adheres to the SPIRIT Guidelines [See S1 Checklist: SPIRIT Guidelines].

Postpartum psychosis: a public involvement perspective across three continents.

Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with stakeholders offers an important avenue to improve clinical practice and make research more impactful, by providing perspectives based on first-hand, expert experience. There is a paucity of reports on stakeholders' engagement in psychiatry. Activities have thus far been limited to Western countries and there are few reports on postpartum psychosis. We report the results of public involvement activities (in the form of discussion groups) with key stakeholders in India, Malawi and the UK. These discussions centred around the clinical picture of postpartum psychosis and the terminologies used to describe these episodes. Seven major areas were highlighted: how postpartum psychosis is handled within services, common symptoms and characteristics, impact of episode, barriers to care, non-medical approaches, terminology and research areas of interest. According to the discussions, postpartum psychosis presents similarly across countries, although there are differences in access to services, approaches to mental health and terminologies used within and across countries. With this understanding comes the foundation for cross-cultural assessment, service improvement and a stakeholder-informed research agenda.

Formation of a stakeholder group of women with a lived experience of Post-partum Psychoses (PP) - Experience from a perinatal psychiatry service in India.

Our paper describes the process of creating a stakeholder group for service development and research in Postpartum Psychosis (PP) at a Perinatal Psychiatry Service in India. We involved women who have recovered from PP as `experts by experience' in identifying areas that need attention from a research and service perspectives. A total of 13 group meetings were conducted, in which 9 group meetings involved women with lived experiences of PP and 4 group meetings were with the family members involved in the care of women during the PP episode. Of the 58 participants, 23 women and two family members expressed their willingness to participate in future stakeholder meetings. Involvement of women with PP and their caregivers as stakeholders in mental health decision-making appears feasible in a LMIC setting and should be encouraged.

Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India-Challenges and Potential Solutions Based on Two Case Reports.

The ongoing COVID-19 pandemic in India has created several challenges in the care of women with perinatal mental illness. Access to healthcare has been disrupted by lockdowns, travel restrictions, and the unavailability of outpatient services. This report aims to discuss the challenges faced by women with severe mental illnesses during the perinatal period with the help of two case reports. Accordingly, we have highlighted the role of COVID-19 infection as a traumatic event during childbirth and its role in triggering a psychotic episode in women with vulnerabilities; difficulties faced by women with postpartum psychosis in accessing perinatal psychiatry services; and the challenges of admission into an inpatient Mother-Baby Unit (MBU). Further, we have discussed potential solutions from the perspectives of Lower and Middle-income (LAMI) countries that need to be extended beyond the pandemic. They include offering video consultations, reviewing hospital policies, and evolving strategies to mitigate traumatic experiences for pregnant and postpartum women with severe mental illnesses in both obstetric and psychiatric care.

A virtual course in perinatal mental health for healthcare professionals.

Screening and treatment of perinatal mental health problems remain inadequate with one of the barrier being non-availability of trained health professionals. Virtual courses have been an important medium to enhance the knowledge and capacity of health professionals. A virtual certificate course in perinatal mental health was developed to train health professionals to identify and treat perinatal mental health disorders. Of the 41 participants, 90.2 % fulfilled the attendance criterion and 75.6 % of them secured the certification. Encouraging feedback (9.54/10) indicated that virtual courses could help enhance competency in health professionals to identify and treat perinatal mental health disorders.

Denial of Pregnancy: Psychopathology and Clinical Management.

Denial of pregnancy (DOP) is a challenging condition with poorly understood psychopathology. DOP is reported to be associated with problems such as severe psychological conflicts, obstetric complications, risks to the newborn, and difficulties in bonding with the infant. In this paper, we present and discuss the clinical manifestations of a severe form of DOP that lasted until the time of delivery with resultant multifaceted complications. Our paper highlights the severity of psychopathology and the need for coordinated management. Descriptions from different cultural backgrounds would improve the conceptual understanding of DOP.