CPH Leads Analysis of Mental Health in Pregnancy: Insights from the Rajarata Pregnancy Cohort
Early identification of mental health problems during pregnancy in low-income and middle-income countries is often underreported. The Center for Public Health (CPH), in collaboration with the Rajarata Pregnancy Cohort (RAPCO) in Sri Lanka, has conducted extensive analysis of RAPCO data, leading to developing a proposed program for mental health intervention in pregnancy. This initiative, detailed in the article “Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka” published in BMJ Global Health 2023;8, provides valuable insights into improving mental health care for pregnant women.
CPH’s analysis of RAPCO data offered significant insights into the screening and management of antenatal anxiety and depression. The programme adopted a two-stage screening approach to identify symptoms and underlying reasons for anxiety and depression among pregnant women.
Screening and Management Approach:
- Two-Stage Screening Approach:
- Initial Screening: Pregnant women (n=3074) less than 13 weeks of gestation were screened using the Edinburgh Postnatal Depression Scale (EPDS).
- Clinical Follow-Up: Women with high EPDS scores underwent clinical (telephone) interviews using the ‘mental health GAP’ tool to screen for clinical depression.
- Interventions:
- Targeted interventions included counselling, financial and social support, and health education.
- The procedure was repeated in the second trimester with in-person clinical interviews and inquiry into intentional self-harm.
This programme highlights the importance of integrating mental health services into routine pregnancy care. By coupling mental health screening with clinical interviews, the programme facilitated targeted, patient-centred care and identified gaps in the routine health surveillance system regarding mental health.
CPH remains dedicated to improving maternal mental health care and will continue to work towards effective, accessible mental health services for pregnant women in low-income and middle-income countries.