Grant: Team Grant: GACD Mental Health - Canada-China

Depression during pregnancy and after an infant’s birth is more common in China than in high-income countries and can harm the mother, infant, and family. Chinese women’s mental health needs are unmet given lack of investment in mental health, unequal distribution of mental health services, and few specialized healthcare providers to support mental health issues. Our goal is to create an effective perinatal depression screening and management (PDSM) program that will be sustainable within the maternal and child healthcare system in China. Our implementation strategy is guided by the Consolidated Framework for Implementation Research and RE-AIM (Reach x Efficacy, Adoption, Implementation, and Maintenance) and includes 2 Phases: (1) Pilot in Ma’anshan City, Anhui Province during which we will, through stakeholder engagement, adapt current evidence and test the feasibility and acceptability of the adapted screening guidelines and psychosocial intervention (internet-based cognitive behavioral therapy; iCBT) by healthcare providers and women. We will use mixed-methods to (a) identify and evaluate various implementation strategies (e.g., individual, organizational) to promote uptake of the screening guidelines and iCBT; (b) evaluate acceptability (i.e., knowledge, attitudes, and behavior) before and after implementation of guidelines and iCBT; (c) evaluate reach by determining the degree to which the population that is eligible to benefit from the program actually received it; (d) evaluate treatment fidelity by determining the extent to which the screening guidelines and iCBT was implemented as designed by monitoring adherence, dosage of delivery (i.e., the number of weeks completed), and program quality. (2) Scale-up to Hefei (capital and largest city), Bengbu (mid-sized urban city), and Fuyang (urban city) adapting the screening guidelines and iCBT based on Phase 1, and using steps (a)-(d) to promote uptake. Our monitoring and evaluation plan includes evaluating impact, effectiveness, and quality (i.e., public health impact) in both the Pilot and Scale-up phases. Our project is jointly supported by Chinese and Canadian researcher, focuses on implementation research related to depression, an affective disorder that will become the second leading cause of disease by 2010. It also, addresses women’s mental health during pregnancy and following birth when vulnerability to depression is intensified, and promotes uptake screening which promotes use of mental health service and iCBT a psychosocial self-administered intervention with support from a trained mental health care provider that promotes reduction in depressive symptoms. Our study will enable integration of PDSM into the maternal and child healthcare system with flexible guidelines that considers context, ensures mental healthcare is personalized and responsive to Chinese women’s needs, and promotes implementation outcomes of acceptability, reach, and fidelity.