The impact of perinatal mental health training on knowledge and practice of primary care physicians: a systems strengthening initiative in Telangana, India.

Abstract

Background: In India, despite the high prevalence of perinatal mental health (PMH) conditions most primary care physicians (PCPs) have inadequate knowledge and skills to identify and provide appropriate interventions. The Health and Family Welfare Department of Telangana, India, partnered with the United Nations Children's Fund (UNICEF) and the Perinatal Mental Health service of the National Institute of Mental Health and Neurosciences to address this gap. The initial step in integrating PMH into the Maternal and child health (MCH) program involved training PCPs. This study aimed to outline the knowledge improvements regarding PMH among PCPs after the training.

Methods: The training, conducted from June to January 2023-2024 across 30 districts, employed various interactive and reflective educational methods. Pre and post-training assessments evaluated knowledge enhancement and skill development, focusing on identifying perinatal anxiety and depression, assessing severity, recognizing risk factors, identifying the need for referrals, and rational psychopharmacology. This study aimed to assess the impact of training on improving knowledge and skills among PCPs which would influence perinatal mental health service delivery in Telangana.

Results: Out of 863 PCPs in the 30 districts, 465 (53.8%) were able to complete the one-day training. Valid pre and post-training responses were available for 374 PCPs. A comparison of pre and post-training scores showed improvement in knowledge in a mean number of risk factors identified (pre: 3.05, post: 5.4; p < 0.001), ability to recognize depression (pre: 2.75, post: 4.33; p < 0.001) and anxiety symptoms (pre: 4.16, post: 6.08; p < 0.001), assess the severity of depression (pre: 0.46, post: 0.85; p < 0.001) and anxiety (pre: 0.57, post: 0.98, p < 0.001), safe medication use during pregnancy (pre: 0.89, post: 2.18;p < 0.001), and during breastfeeding (pre: 1.07, post: 2.13; p < 0.001) and identifying the need for referral to a psychiatrist (pre: 1.90, post: 3.13; p = 0.003).

Conclusion: The one-day training for PCPs enhanced knowledge across various PMH domains. However, studies with follow-up data are necessary to assess the retention of this knowledge and skills related to case identification and referrals. Such studies will provide a more comprehensive evaluation of the effectiveness of the training program.