Perceptions of postnatal depression and health care needs in a South African sample: the "mental" in maternal health care.
BACKGROUND
Maternal mental health care is a neglected area in low and middle income countries (LAMIC) such as South Africa, where maternal and child health care priorities are focused on reducing maternal and infant mortality and promoting infant physical health. In the context of a paucity of mental health specialists, the aim of this study was to understand the explanatory models of illness held by women with maternal depression with the view to informing the development of an appropriate counselling intervention using a task sharing approach.


METHODS
Twenty semi-structured qualitative interviews were conducted with mothers from a poor socio-economic area who were diagnosed with depression at the time of attending a primary health care facility. Follow-up interviews were conducted with 10 participants in their homes.


RESULTS
Dimensions of poverty, particularly food and financial insecurity and insecure accommodation; unwanted pregnancy; and interpersonal conflict, particularly partner rejection, infidelity and general lack of support were reported as the causes of depression. Exacerbating factors included negative thoughts and social isolation. Respondents embraced the notion of task sharing, indicating that counselling provided by general health care providers either individually or in groups could be helpful.


CONCLUSIONS
Counselling interventions drawing on techniques from cognitive behavioural therapy and problem solving therapy within a task sharing approach are recommended to build self-efficacy to address their material conditions and relationship problems in poorly resourced primary health care facilities in South Africa.
Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Durban 4041, South Africa. Kathree@ukzn.ac.za.
Tasneem
T
Kathree
One M
OM
Selohilwe
Arvin
A
Bhana
Inge
I
Petersen
D000328:Adult; D001294:Attitude to Health; D019052:Depression, Postpartum / Q000523:psychology*; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D005523:Food Supply; D006301:Health Services Needs and Demand; D006801:Humans; D007398:Interpersonal Relations; D008427:Maternal Health Services; D008605:Mental Health Services; D008875:Middle Aged; D011203:Poverty / Q000523:psychology; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000523:psychology; D036301:Qualitative Research; D012934:Social Isolation / Q000523:psychology; D012944:Social Support; D013019:South Africa; D013179:Spouse Abuse / Q000523:psychology; D055815:Young Adult