Service Coordination to Address Maternal Mental Health, Partner Violence, and Substance Use: Findings from a National Survey of Home Visiting Programs

Perinatal women enrolled in home visiting (HV) programs exhibit high rates of depression, substance use, and intimate partner violence (IPV). While HV programs have increasingly screened for these psychosocial risks, initiation and uptake of community-based services to address these risks remain challenging. This project used a community-engaged research approach to engage key HV stakeholders in developing the screening, referral, and individualized prevention and treatment (SCRIPT) model. We highlight how a group of key HV stakeholders—the SCRIPT Advisory Panel—collaborated with academic researchers to develop the SCRIPT model by reviewing literature on HV programs’ response to psychosocial risk factors and qualitative data obtained from mental health, substance use, and IPV service providers to whom HV programs referred clients. SCRIPT focuses on (a) screening for psychosocial risks, (b) developing partnerships with outside agencies to address these risk factors, and (c) establishing concrete and systematic processes for client referral and monitoring with outside agencies. SCRIPT provides a structured model for HV programs to systematically identify clients for key psychosocial risks and structure their referral and monitoring process when working with social service agencies. Future work should examine the impact of SCRIPT on mental health, substance use, and IPV service access and use by a vulnerable population.

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Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study

International Journal of Mental Health Systems ◽

10.1186/s13033-020-00407-1 ◽

2020 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Mark Tomlinson ◽

Deepika Chaudhery ◽

Habibullah Ahmadzai ◽

Sofía Rodríguez Gómez ◽

Cécile Bizouerne ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Depressive Symptoms ◽

Feasibility Study ◽

Partner Violence ◽

Postnatal Depression ◽

Home Visiting ◽

Health Workers ◽

Psychological Intervention ◽

Maternal Mental Health

Abstract Background The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery. Methods This exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme. Results Of the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention. Conclusion In poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce.

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Perinatal mental health around the world: priorities for research and service development in Africa

BJPsych International ◽

10.1192/bji.2020.16 ◽

2020 ◽

Vol 17 (3) ◽

pp. 56-59 ◽

Cited By ~ 1

Author(s):

Mwawi Ng'oma ◽

Tesera Bitew ◽

Malinda Kaiyo-Utete ◽

Charlotte Hanlon ◽

Simone Honikman ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Partner Violence ◽

Large Scale ◽

Infant Health ◽

Common Mental Disorders ◽

Maternal Mental Health ◽

Service Development ◽

Middle Income ◽

The Right

Africa is a diverse and changing continent with a rapidly growing population, and the mental health of mothers is a key health priority. Recent studies have shown that: perinatal common mental disorders (depression and anxiety) are at least as prevalent in Africa as in high-income and other low- and middle-income regions; key risk factors include intimate partner violence, food insecurity and physical illness; and poor maternal mental health is associated with impairment of infant health and development. Psychological interventions can be integrated into routine maternal and child healthcare in the African context, although the optimal model and intensity of intervention remain unclear and are likely to vary across settings. Future priorities include: extension of research to include neglected psychiatric conditions; large-scale mixed-method studies of the causes and consequences of perinatal common mental disorders; scaling up of locally appropriate evidence-based interventions, including prevention; and advocacy for the right of all women in Africa to safe holistic maternity care.

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The impact of cohort substance use upon likelihood of transitioning through stages of alcohol and cannabis use and use disorder: Findings from the Australian National Survey on Mental Health and Wellbeing

Drug and Alcohol Review ◽

10.1111/dar.12679 ◽

2018 ◽

Vol 37 (4) ◽

pp. 546-556 ◽

Cited By ~ 7

Author(s):

Louisa Degenhardt ◽

Meyer Glantz ◽

Chrianna Bharat ◽

Amy Peacock ◽

Luise Lago ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

National Survey ◽

Cannabis Use ◽

Health And Wellbeing ◽

The Impact

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Exploring links between common mental health problems, alcohol/substance use and perpetration of intimate partner violence: A rapid ethnographic assessment with men in urban Kenya

Global Mental Health ◽

10.1017/gmh.2017.25 ◽

2018 ◽

Vol 5 ◽

Cited By ~ 4

Author(s):

A. Schafer ◽

P. Koyiet

Keyword(s):

Mental Health ◽

Intimate Partner Violence ◽

Substance Use ◽

Alcohol Use ◽

Marital Conflict ◽

Partner Violence ◽

Mental Health Problems ◽

High Stress ◽

Intimate Partner ◽

Psychosocial Issues

Introduction:Kenya has some of the highest rates of gender-based violence (GBV) in the world, particularly intimate partner violence. World Vision completed a rapid ethnographic assessment to explore common problems faced by men and local perspectives about the links between men, mental health, alcohol use and GBV.Methods:Data from community free-listing surveys (n = 52), four focus group discussions and two key informant interviews formed the basis for thematic analysis and findings.Results:Lack of jobs, ‘idleness’ and finances were viewed as top priority concerns facing men; however, alcohol and substance use were equally prioritised. Family problems, crime and general psychosocial issues (e.g., high stress, low self-esteem) were also reported. Men withdrawing socially, changing behaviour and increasing alcohol consumption were described as signs that men were experiencing mental health challenges. The community observed alcohol use as the biggest cause of GBV, believing men resorted to drinking because of having ‘too much time’, marital conflict, psychosocial issues and access to alcohol. The findings theorise that a circular link between unemployment, alcohol and crime is likely contributing to familial, psychosocial and gender concerns, and that men's mental health support may assist to re-direct a trajectory for individuals at risk of perpetrating GBV.Conclusions:Data confirmed that GBV is a major concern in these Kenya communities and has direct links with alcohol use, which is subsequently linked to mental health and psychosocial problems. Attempting to disrupt progression to the perpetration of violence by men, via mental health care interventions, warrants further research.

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Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000864 ◽

2020 ◽

Vol 29 ◽

Author(s):

W. A. Tol ◽

M. C. Greene ◽

M. E. Lasater ◽

K. Le Roch ◽

C. Bizouerne ◽

...

Keyword(s):

Mental Health ◽

Exclusive Breastfeeding ◽

Home Visiting ◽

Health Workers ◽

Maternal Mental Health ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Child Height ◽

Low And Middle Income

Abstract Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

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Maternal Mental Health and Children’s Internalizing and Externalizing Behaviors: Beyond Maternal Substance Use Disorders

Journal of Child and Family Studies ◽

10.1007/s10826-013-9874-3 ◽

2013 ◽

Vol 24 (3) ◽

pp. 638-648 ◽

Cited By ~ 18

Author(s):

Yih-Ing Hser ◽

H. Isabella Lanza ◽

Libo Li ◽

Emily Kahn ◽

Elizabeth Evans ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Substance Use Disorders ◽

Externalizing Behaviors ◽

Maternal Mental Health ◽

Internalizing And Externalizing Behaviors ◽

Maternal Substance Use ◽

Internalizing And Externalizing

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Aggressive behavior of children exposed to intimate partner violence: An examination of maternal mental health, maternal warmth and child maltreatment

Child Abuse & Neglect ◽

10.1016/j.chiabu.2012.12.006 ◽

2013 ◽

Vol 37 (8) ◽

pp. 520-530 ◽

Cited By ~ 58

Author(s):

Megan R. Holmes

Keyword(s):

Mental Health ◽

Intimate Partner Violence ◽

Child Maltreatment ◽

Aggressive Behavior ◽

Partner Violence ◽

Maternal Mental Health ◽

Intimate Partner ◽

Maternal Warmth

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How Adolescents, Mothers, and Fathers Qualitatively Describe Their Experiences of Co-Occurrent Problems: Intimate Partner Violence, Mental Health, and Substance Use

Journal of Interpersonal Violence ◽

10.1177/0886260519900968 ◽

2020 ◽

pp. 088626051990096 ◽

Cited By ~ 1

Author(s):

Geneviève Lessard ◽

Sylvie Lévesque ◽

Chantal Lavergne ◽

Annie Dumont ◽

Pamela Alvarez-Lizotte ◽

...

Keyword(s):

Mental Health ◽

Intimate Partner Violence ◽

Substance Use ◽

Partner Violence ◽

Intimate Partner ◽

Analysis Method ◽

Structured Interviews ◽

Mothers And Fathers ◽

Future Studies ◽

Content Analysis Method

This qualitative study examines the perceptions of mothers, fathers, and adolescents on the relations they see between intimate partner violence, mental health and substances use parental problems that co-occur in their family, and the mothers’ and fathers’ associated parenting challenges. The sample was composed of 43 people (15 mothers, 16 fathers, and 12 adolescents) who were directly affected by the co-occurrence of intimate partner violence and mental health or substances use parental problems. The participants were recruited with the collaboration of public and community organizations in the Province of Québec (Canada). The data were collected through semi-structured interviews and combined with a table detailing the specific problems identified by the participants. A thematic content analysis method was employed to do the coding, and a summary of the results was returned to some participants who agreed to collaborate with the validation of the results. The analysis revealed numerous and diverse relations between the interviewees’ co-occurring problems, but two principal patterns emerged. The first one was chiefly observed in the comments made by mothers and adolescents who saw the co-occurring problems as being the consequence of the intimate partner violence on the mother. The second pattern was largely observed in the fathers’ comments, who explained that the substance use problems came before the intimate partner violence and acted as an aggravating factor. The co-occurrence of intimate partner violence with other parental problems strongly affected the mothers’ and fathers’ parenting, making it more difficult to meet the children’s needs. Considering the complexity and diversity of the experiences and needs of the mothers, fathers, and children in co-occurring situations, future studies should evaluate the services provided to these families and the coordination between the different concerned organizations.

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