JMIR Publications

ABSTRACT

Background:

Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly half of all mothers face common mental disorders, but mental health services and trained professionals are scarce to serve this need. To address this, the Government of Bangladesh's NCDC Programme initiated the "Wellbeing Centre," a tele-mental health service in selected public hospitals.

Objective:

This study examines the implementation outcomes of the Wellbeing Centre, with a particular focus on antepartum and postpartum women.

Methods:

Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services, along with 168 healthcare providers, at six Wellbeing Centres in four districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization’s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires. Descriptive statistics and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews (IDIs) and key informant interviews (KIIs).

Results:

Among 168 health care providers, almost everyone (99%) reported that the Wellbeing Centre is feasible to implement in their health facilities, however, about half (50%) felt the lack of sufficient trained staff to operate. Almost all women agreed that Wellbeing Centre is acceptable (99.9%) and useful (99.9%), and its enhanced accessibility to mental healthcare (99%). Patients visiting district-level hospitals had higher odds of accessibility (aOR:1.5; 95% CI: 1.1-2.0) to Wellbeing Centres. Besides, 77.3% women experienced depressive and 76.7% women experienced anxiety symptoms. About 52% experienced tiredness or lack of energy, 51% felt nervous, anxious, or on edge, and 57% felt worries and 4% had suicidal ideation almost every day. Patient visiting the district hospitals had higher odds (aOR: 2.6; 95% CI: 1.8-3.78) of both depression and anxiety symptoms compared to the patients visiting sub-district level hospitals. The decreasing trend of average PHQ-9 score (from 14.2 to 12.7) and GAD-7 score (from 12.9 to 12.0) between two counselling sessions indicated an improved mental health in antepartum and postpartum women. The Wellbeing Centres’ services are appreciated for their health providers, free and accessible treatment, and privacy. However, stigma, postpartum illness, and long waiting times prevented some women from utilising these services.

Conclusions:

To our knowledge, this is the first implementation research assessing tele-mental health in public health facilities involving a pool of trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centres for antepartum and postpartum women in Bangladesh. This supports evidence-based decisions for introducing and scaling up Wellbeing Centres in Bangladesh and other low- and middle-income countries.