This article is written by Erin Pfeiffer, senior technical advisor in health and nutrition at Food for the Hungry.

For many women, becoming a mother is one of life’s major milestones. But we also know that for some women, the first step towards motherhood can be a hard one.

In low- and middle-income countries, a staggering one in five mothers experiences depression after birth. These women are at increased risk of depression due to factors such as war, gender-based violence, and extreme poverty. And while more than 80% of all people live in low- and middle- income countries, the number of mental health workers in these countries can be as low as 2 per 100,000 people, compared to more than 70 in high-income countries.

This is a devastating fact, given that 1 in every 10 people are estimated to need mental health services at any given time. For this reason, community-based, low-cost interventions are crucial to meeting the needs of the population.

When a mother or a caregiver becomes depressed, it affects her own wellbeing and also can impact the growth and development of the child. Children’s early nutritional development is essential to lifelong cognitive and physical health, which means the impact of maternal depression can be dire in those first days and early years of a child’s life.

While we’re seeing a global trend of de-stigmatisation of mental health, maternal depression is unfortunately still too often ignored

But while we’re seeing a global trend of de-stigmatisation of mental health, maternal depression is unfortunately still too often ignored in the global health and nutrition practitioner community.

The good news is that caregiver mental disorders are treatable. Effective interventions can be delivered by well-trained, non-specialist providers. The implications may apply to mothers worldwide.

Addressing depression

We conducted a new study of 1,200 depressed Ugandan mothers, which provides fresh insight into the connection between maternal depression, depression treatment, and impact on the uptake of commonly promoted health and nutrition behaviours.

The study, led by Food for the Hungry in conjunction with Columbia University, Johns Hopkins University and World Vision International and with financial support from the Eleanor Crook Foundation, aimed to understand the role depression plays in a mother’s ability to care for her child’s health and nutrition needs. Through a randomised controlled trial, we tested the hypothesis that the World Health Organisation-endorsed Interpersonal Therapy for Groups (IPT-G) approach — a community-based, empirically-supported attachment-focused psychotherapy — can reduce maternal depression and, in doing so, increase women’s ability to adopt life-saving health and nutrition actions for their children.

In the IPT-G model, a group of 8-10 women gather together weekly — often in a shaded, private outdoor space — with a trained facilitator. During the 90-minute sessions, women’s depressive symptoms are classified into one or more of four problem areas: grief, role disputes, role transition, and interpersonal conflict. After introductions and check-ins, facilitators gently work with each woman on examining negative thoughts, behaviours, and attitudes and their impact.

They collaboratively develop target goals related to the problem area and group perspectives are shared. IPT-G has been implemented globally since the 1960s, rigorously studied, and validated as a low-cost approach to treat depression in low-resource settings.

Life-saving behaviours

In the research trial, half the depressed mothers were randomised to receive 3 months of weekly IPT-G treatment, followed by 15 months of peer-to-peer health education through Care Groups. The other half of the women, the control group, participated in Care Groups but did not receive IPT-G intervention.

Care Groups is an evidence-based behaviour change model that uses community-based health volunteers. These volunteers, often mothers, educate and engage their peers in behaviours that encourage everything from proper breastfeeding and understanding toddler nutrition needs to the importance of boiling water and vaccinating children. These mothers in turn train more mothers, resulting in a ‘cascade’ effect of peer-based training, learning and encouragement.

Our study found a strong connection between depression and the ability to fully engage in life-saving behaviours.

For 10 out of 12 of the indicators we studied, depressed women adopted none of the important health and nutrition behaviours, such as breastfeeding, recognising when their infant was sick, and proper hand-washing

Women who suffer from depression demonstrated significant inability to adopt actions that impact child health and nutrition outcomes. For 10 out of 12 of the indicators we studied, depressed women adopted none of the important health and nutrition behaviours, such as breastfeeding, recognising when their infant was sick, and proper hand-washing — whereas non-depressed women were able to readily practice these critical actions.

The study also found that women treated with IPT-G recovered faster from depression than mothers in the control group 6 weeks after treatment and had significantly better perceived social support from others and the ability to perform activities of daily living. However, by the end of the research trial, depression among participants in both the treatment and control groups declined to similarly low levels, which may be due to a therapeutic effect of the Care Group intervention itself. Understanding the potential impact of Care Groups on depression and behaviour change among depressed women will be an important next step for further research.

What governments can do

These early findings highlight that when it comes to improving child health and nutrition, addressing caregiver mental health is essential. And for many individuals suffering from adverse life events or mental distress, even a modest degree of psychosocial support from a community-based facilitator and peers can go a long way.

Psychosocial support interventions can be initiated by national governments or non-governmental organisations, and then sustained by the community. Currently, few government ministries or the international NGO community integrate mental health into their traditional health programs. With this study, we hope to emphasise to the global health community that addressing caregiver mental health is a critical component of improving outcomes for caregivers and their children.

To this end, Food for the Hungry is launching a set of Caregiver Mental Health Knowledge Sharing Series initiatives to be a part of the growing momentum of implementers, researchers, advocates and funders who are addressing caregiver mental health as a component of improving the health, nutrition, and overall welfare of individuals and communities.

This on-going series of in-person events in the US and Africa and web-based consultations aim to: promote the exchange of knowledge, evidence and resources; identify opportunities for increased attention to and funding for integration of mental health interventions into global policy and programming; drive future research and advance implementation of best practices to fill gaps; and form mutually beneficial collaborations and partnerships.

Visit caregivermentalhealth.org or contact us to learn more. — Erin Pfeiffer

(Picture Credit: Unsplash)

Erin Pfeiffer is the senior technical advisor in health and nutrition at Food for the Hungry, a leading international relief and development organi__sation ending poverty in over 20 countries worldwide. She holds a Masters in Public Health from the Harvard School of Public Health and has more than 15 years’ experience living and working globally to improve the lives of women and children.

Make sure to share your own thoughts with the author by leaving a comment below