Feasibility and acceptability of a community health worker administered behavioral activation intervention for postpartum depression: a single arm pilot study from India.

Introduction: Women in India experience high rates of postpartum depression (PPD), with minimal availability of screening or treatment. India has an extensive network of community health workers, known as accredited social health activists (ASHAs). While they are knowledgeable about most maternal-child health problems, they have minimal knowledge about PPD. We trained ASHAs to deliver a simple home-based intervention, behavioral activation (BA), which involves individuals in activities that are sources of positive reinforcement to counter depression. The research questions guiding this study were as follows: 1) What are the feasibility and acceptability of ASHAs screening for and delivering a brief behavioral activation intervention addressing PPD among women in Belagavi, South India? 2) What impact did the brief behavioral activation intervention have on PPD? Methods: The mixed methods evaluation used interviews with participants and interventionists, and depression scores were assessed before and after the evaluation. After a 2-day training with 17 ASHAs that focused on understanding PPD, screening using the Edinburgh Postnatal Depression Scale (EPDS), and implementing the BA protocol, ASHAs and researcher supervisors screened the mothers 6-12 weeks postpartum presenting at pediatric immunization clinics. Mothers who screened positive were invited to participate in an ASHA-led 5-week BA intervention, with ASHAs visiting the mothers' homes. We assessed post-intervention EPDS scores and conducted satisfaction assessments and individual interviews. Results: All 26 women who screened positive on the EPDS agreed to be enrolled in the study. All participants had a significant reduction (p < 0.001) in PPD scores. Both ASHAs and mothers had high enthusiasm for the intervention methods and activities. Discussion: This ASHA-delivered BA intervention was found to be feasible, acceptable, and effective in treating PPD in rural Indian mothers. This corroborates literature that demonstrates the efficacy of a BA intervention among individuals with generalized depression in South Asia. In communities with minimal mental health resources, interventions led by trained community workers have the potential to address PPD.

Postpartum Depression in India: Perceptions by Key Stakeholders.

While postpartum depression (PPD) rates in India are among the highest in the world, screening and treatment is minimal. Socio-cultural issues including perceptions of stakeholders play role in this treatment gap. Efficient identification and treatment of women experiencing PPD has great importance for not only maternal, but infant outcomes. Infants born to mothers with PPD have a higher likelihood of lower birth weight, breastfeeding, maternal-infant bonding, and even cognitive delays throughout childhood. With the goal of improving maternal mental health outcomes, researchers conducted group and individual interviews with 26 stakeholders working with peripartum women in India to explore social perceptions of PPD. Analysis followed the social ecological model (SEM). Three themes were found: low awareness, minimal resources, and traditions and customs. Conclusion: Findings of this research can be used to develop interventions based on the three themes and their relation to the facets of the SEM framework.