Data-Driven Cutoff Selection for the Patient Health Questionnaire-9 Depression Screening Tool.

Importance: Test accuracy studies often use small datasets to simultaneously select an optimal cutoff score that maximizes test accuracy and generate accuracy estimates.

Objective: To evaluate the degree to which using data-driven methods to simultaneously select an optimal Patient Health Questionnaire-9 (PHQ-9) cutoff score and estimate accuracy yields (1) optimal cutoff scores that differ from the population-level optimal cutoff score and (2) biased accuracy estimates.

Design, Setting, And Participants: This study used cross-sectional data from an existing individual participant data meta-analysis (IPDMA) database on PHQ-9 screening accuracy to represent a hypothetical population.

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

An amendment to this paper has been published and can be accessed via the original article.

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

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.

Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study.

Background: Rates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence.

Methods: We recruited adult women attending antenatal services at a primary-level maternity facility.

Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women.

Background: Antenatal depression and anxiety disorders are highly prevalent in low and middle-income countries. Screening of pregnant women in primary care antenatal settings provides an opportunity for entry to care, but data are needed on the performance of different screening tools. We compared five widely-used questionnaires in a sample of pregnant women in urban South Africa.

Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study.

Anxiety is highly prevalent in many populations; however, the burden of anxiety disorders amongst pregnant women in low-resource settings is not well documented. We investigated the prevalence and predictors of antenatal anxiety disorders amongst low-income women living with psychosocial adversity. Pregnant women were recruited from an urban, primary level clinic in Cape Town, South Africa.

Antenatal depression and adversity in urban South Africa.

Background: In low and middle-income countries (LMIC), common mental disorders affecting pregnant women receive low priority, despite their disabling effect on maternal functioning and negative impact on child health and development. We investigated the prevalence of risk factors for antenatal depression among women living in adversity in a low-resource, urban setting in Cape Town, South Africa.

Methods: The MINI Neuropsychiatric Interview (MINI Plus) was used to measure the diagnostic prevalence of depression amongst women attending their first antenatal visit at a primary-level, community-based clinic.

Predictors of alcohol and other drug use among pregnant women in a peri-urban South African setting.

Background: Alcohol and other drugs (AOD) use among pregnant women have been associated with adverse health outcomes for mother and child, during and after pregnancy. Factors associated with AOD use among women include age, poverty, unemployment, and interpersonal conflict. Few studies have looked at demographic, economic, and psychosocial factors as predictors of AOD use among pregnant women in low-income, peri-urban settings.

Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa.

As one article in a series on Global Mental Health Practice, Simone Honikman and colleagues from South Africa provide a case study of the Perinatal Mental Health Project, which delivered mental health care to pregnant women in a collaborative, step-wise manner, making use of existing resources in primary care.

Improving child outcomes through maternal mental health interventions.

This commentary will provide a general overview of the public health considerations of maternal mental illness, both from a global perspective as well as from the South African context. The paper will outline the consequences of maternal mental illness for mothers as well as their offspring, through the life stages from pregnancy until adulthood. The paper then describes the Perinatal Mental Health Project (PMHP), an intervention that addresses maternal mental health in Cape Town, South Africa.