atif.rahman@liverpool.ac.uk

Outline:psychot

Developments in the field of psychotherapy for mental health problems, using perinatal depression as a case study.

PUBLIC MENTAL HEALTH CONTEXT

an over-populated area having scarcity of HR, Overburdened health systems

Deprived mental health (cinderella) overlooked in medicine

Stigma in society discrimination, Medically discriminated also

low literacy is the cherry on top

how this type of society will get talking therapy?

PERINATAL DEPRESSION leads to poor function and self-care
 1/4 antepartum depression 250000/million

1/5 postpartum depression 200000/million

Developed countries suffer the same as china

poor socioeconomic status, low education, ill health and low social support are key factors

IMPACT is on
Fetus, low prenatal-postnatal care, breastfeeding, malnutrition, diarrheal, poor healthcare, disrupted child behaviour, 

 

MATERNAL DEPRESSION: GLOBAL THREAT

LOWEST rate of HR for mental health

can the lowest no. of mental health professionals provide better services to that high number.?

this is much expensive behaviour

SOLUTION
WHO endorsed Task-Shifting/sharing
Services through non-professionals
Can Psychotherapy be delivered by non-specialists after little training and supervision?

Lady health workers program

talking therapy through these people, a long systematic system

THINKING HEALTHY PROGRAMME

overcome lack of specialists

home-based therapy to overcome stigma by health workers

5 days of training, hands-on practical 

application through role play

learning on the job to work more efficiently

16 sessions, 4 delivered before pregnancy, 4 after pregnancy, where 8 were optional
simple and easy steps of 45 min each
Cognitive Behaviour Therapy Most active talking therapy.

INGREDIENTS
a) Specific:

1- Guided discovery using pics to replace negative thoughts with positive thoughts, implement positive thinking

2- Behavioural Activation breaking large tasks into small manageable/doable tasks, Powerful intervention for depression. a lot of encouragement
3- Problem-Solving by brainstorming with both mother and family

 

b) Non-Specific
Empathy ability to feel pain and respond in a proper way, so the mother attains the required social support.

 

3 Areas of thinking

self-care, relation with baby & significant other

support the mother through difficult times

 

STIGMA

using child development as an entry point and persuading them to work as support

Low Literacy
Using pictorial presentation for different moods

narrative of characters that can she relate to

narratives and pics help to elevate the behaviour without monitoring 1-1

5 days training
simple yet rigid instructions to play all the steps accordingly

Intervention therapy was more influential.

positive impacts on child care and self-care

intervention is more suitable due to more liking by the women 

Challenges of scaling up

requires further assistance

health workers are already overburdened with their respective tasks

Peers are effective to deliver services to society.

cost-effective therapy

 When intervention deviates its programme drift
if it losses potency its voltage drop
Digital tools to deliver services to the community

the plethora of technology is non-regulated

using technology to scale up system's inbuilt modules

A randomized controlled trial demonstrates that it is as effective as face to face system

the app is effective as peer or worker

 

psychoterapy n.精神疗法；心理疗法

perinatal depression 围产期抑郁症

task-shifting（sharing）and technology

prevalence n.盛行；普遍；（疾病等的）流行程度

scale-up n.按比例增加，扩大

scarcity n.不足，缺乏，稀少

chronic adj.慢性的，长期的 ，积习难改的

perinatal depression  临产抑郁

prevalence 流行；概率

maternal  母亲的

CBT 认知行为治疗

 

Perinatal depression:

1. low mood
2. fatigue
3. anxiety
4. negative thoughts
5. feeling of guilt
6. avoiding people

 

leading to poor functioning and lack of self-care

 

Prevalence(流行率) in women:

antepartum:1/4（产前）

postpartum:1/5（产后）

In china: 16.3% 

 

Maternal depression can undermine the development of young children

 

Task-shifting(sharing): delivery of psychological interventions through non-speciallists

 

CBT:认知行为疗法

Active ingredients:

1. guided discovery
2. behavior activation
3. problem solving

+empathy and social support

 

Areas of thinking healthy

self-care and well-being

relationship with baby and significant others

 

overburdened community health workers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

心理治疗的发展历程，和以产后抑郁症为例进行研究。LMIC的公共精神卫生背景，