Adaptation of a Screening Tool for Perinatal Depression and Anxiety in Community‐Based Maternal Health Services in Mali

摘要

Purpose The aim of this research is to adapt and validate a perinatal depression and anxiety screening tool in Mali, West Africa for use in community‐based maternal mental health prevention interventions. Research Questions How do standardized screening tools for depression and anxiety align with maternal depression and anxiety symptomatology in Mali? Is the adapted depression and anxiety screening tool valid and reliable? Significance Midwives in low‐resource settings such as Mali provide the majority of maternal health services with few resources. As with other threats to maternal and newborn well‐being, perinatal depression is a significant cause of morbidity and mortality including poor perinatal outcomes and infant development. However, mental health issues are rarely included in maternal health programming, and local midwives have few tools to address the issue. An important component of maternal care is screening for depression and anxiety with a tool based on local ethnomedical understandings of mental health. Western screening tools have been adapted and validated in other low‐income contexts but not in the Malian context. Such a tool has the potential to provide midwives with a way to identify women who need mental health support. Methods We are using a mixed‐methods study to adapt and validate a postpartum depression and anxiety screening tool using the DIME Program Research Model: Design, Implementation, Monitoring, and Evaluation. Focus groups and interviews conducted in Sélingué, Mali in 2016 provided local terms and symptomatology upon which to base the adaptation of screening tools. A pretest was conducted among local midwives in Sélingué in June 2016, and additional pretests with community women are ongoing; additional interviews to establish reliability and validity with childbearing women took place in September of 2016. Results To date, multiple elements of the Edinburgh Postnatal Depression Scale and Hopkins Symptom Checklist were expressed locally. Some elements from established screeners were not locally relevant, and new elements were added to the adapted tool. Discussion Perinatal depression in low‐resource settings requires locally relevant screening tools. Such tools are necessary for community‐based efforts to integrate perinatal depression screening, prevention, and intervention into routine care in Mali.