Perinatal mental health and its social determinants: qualitative findings from rural Telangana.

BACKGROUND

The prevalence and severity of perinatal common mental disorders (CMDs) are disproportionately high in India and other low- and middle- income contexts. Since social determinants strongly influence perinatal CMDs, they represent promising targets for alleviating the burden of disease in these countries. This study aimed to understand (1) social determinants of perinatal mental health and their concepts, context, interactions, facilitators, and impact and (2) how interventions targeting these determinants should be designed and implemented in Telangana and similar regions across rural South India.

METHODS

Nine focus group discussions and eight individual interviews were conducted to capture perspectives from a total of 65 stakeholders, including community health workers, women at risk for perinatal CMDs, their caregivers, treatment providers, and village leaders in eight villages across the Siddipet district of Telangana, India. Social determinants were derived from the resulting narratives through a thematic analysis with a hybrid inductive and deductive approach.

RESULTS

Thirty-six social determinants of perinatal mental health were identified and mapped onto the six levels of influence (individual, interpersonal relationships, organizations, community, policy, society) within the socio-ecological model of perinatal mental health. Across these six levels, five themes regarding these social determinants and their relationships, context, and influence on perinatal mental health in Telangana emerged: attitudes about pregnancy outcomes, gender inequity, relationships and support, mental health stigma, and mental healthcare access. Considerations for perinatal CMD interventions that participants proposed are also presented, along with our practical suggestions to address them.

CONCLUSIONS

A wide range of social determinants impact perinatal mental health within Telangana. Since these factors often have impacts across multiple levels of influence, interventions should employ a multi-faceted, intersectoral approach to effectively prevent, recognize, and treat perinatal CMDs in Telangana and similar regions across rural South India.

CLINICAL TRIAL NUMBER: Not applicable.