Integration of Stepped Care for Perinatal Mood and Anxiety Disorders Among Women Attending Maternal and Child Health Clinics

What this Trial Is About

Perinatal mood and anxiety disorders (PMAD), including depression and anxiety during pregnancy or up to one year after childbirth, affect many birthing people worldwide, especially in low- and middle-income countries. These disorders often go undetected and untreated due to limited access to mental health services. This trial aims to evaluate a stepped-care intervention designed to improve screening and treatment of PMAD among perinatal women attending maternal and child health clinics in Kenya, addressing important clinical and implementation outcomes. The study compares two groups: control facilities providing enhanced standard care with basic screening and referral information, and intervention facilities offering the Integrated Perinatal Mental Health Program (IPMH). The IPMH includes systematic screening with PHQ-2 and GAD-2, followed by more detailed assessments for positive cases, weekly counseling sessions called Problem Management Plus (PM+) for women with likely depression or anxiety, and telepsychiatry support for severe symptoms or non-responders. The program aims to integrate these interventions into routine care at clinics in Western Kenya. Participants will be assessed from pregnancy through six months postpartum. Researchers will monitor mental health symptoms using validated screening tools, evaluate quality of life, pregnancy outcomes, and use of coping skills. The study includes regular visits to maternal and child health clinics for screening and treatment sessions. Safety monitoring includes assessing risk of self-harm. The total study duration for each participant covers pregnancy and six months after delivery, with ongoing evaluations to determine the intervention's impact and feasibility in these settings.

Integration of Stepped Care for Perinatal Mood and Anxiety Disorders Among Women Attending MCH Clinics