Research

The PMHP conducts integrated research to develop and refine maternal mental health service models.

In collaboration with regional mental health consortia through the Alan J Flisher Centre for Public Mental Health (CPMH), we support mental health research, implementation and evaluation in low-income countries. 

We generate knowledge to support the implementation of an evidence-based package of care for maternal mental health, in low-resource settings. We continuously evaluate our tools, training and support materials to improve quality of our care package. We continuously conduct research in our clinical sites to generate new knowledge.

Research Publications

Synthesising Global and Local Knowledge for the Development of Maternal Mental Health Care: Two Cases from South Africa (2017)
S Cooper, S Honikman, I Meintjes, M Tomlinson, The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, Chapter 23
Weblink

Perinatal suicidal ideation and behaviour: psychiatry and adversity (2016)
M N Onah, S Field, J Bantjes, S Honikman, Archives of Women’s Mental Health; DOI: 10.1007/s00737-016-0706-5
Weblink | PDF

Maternal mental health and the first 1 000 days (2016)
R E  Turner, S Honikman, South African Medical Journal;106(12):1164-1167. DOI:10.7196/SAMJ.2016.v106.i12.12129
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Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs (2016)
J E M Nakku, E S Okello, D Kizza, S Honikman, J Ssebunnya, S Ndyanabangi, C Hanlon, F Kigozi, BMC Health Service Research, DOI 10.1186/s12913-016-1547-7
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Antenatal depression and adversity in urban South Africa (2016)
T v Heyningen, L Myer, M N Onah, M Tomlinson, S FieldS Honikman, Journal of Affective Disorders, DOI:10.1016/j.jad.2016.05.052
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Predictors of alcohol and other drug use among pregnant women in a peri-urban South African setting (2016)
M N Onah, S FieldT v Heyningen, S Honikman, International Journal of Mental Health SystemsDOI: 10.1186/s13033-016-0070-x
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Integrating mental health into South Africa’ s health system : current status and way forward (2016)
M Schneider, E C Baron, E Breuer, SDocrat, S Honikman, A Kagee, M N Onah, S Skeen, K Sorsdahl, M Tomlinson, C vd Westhuizen, C Lund, South African Health Review, 2016, Chapter 13, Durban: Health Systems Trust
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Breastfeeding in South Africa : are we making progress? (2016)
Lisanne du Plessis, Nazia Peer, Simone Honikman, René English, South African Health Review, 2016, Chapter 10, Durban: Health Systems Trust
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Maternal mental health in primary care in five low- and middle-income countries: a situational analysis (2016)
E C Baron, C Hanlon, S Mall, S Honikman, E Breuer1, T Kathree, N P Luitel, J Nakku, C Lund, G Medhin, V Patel, I Petersen, S Shrivastava, M Tomlinson, Health Services Research, 2016, DOI 10.1186/s12913-016-1291-z
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District mental healthcare plans for five low-and middle-income countries: commonalities, variations and evidence gaps (2015)
C Hanlon, A Fekadu, M Jordans, F Kigozi, I Petersen, R Shidhaye, S Honikman, C Lund, M Prince, S Raja, G Thornicroft, M Tomlinson, V Patel, British Journal of Psychiatry, 2015 Oct 7. pii: bjp.bp.114.153767.
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Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: Rationale, Overview and Methods of AFFIRM (2015) 
C Lund, A Alem, M Schneider, C Hanlon, J Ahrens, C  Bandawe, J Bass, A Bhana, J Burns, D Chibanda, F Cowan, T Davies, M Dewey, A Fekadu, M Freeman, S Honikman, J Joska, A Kagee, R Mayston, G Medhin, S Musisi, L Myer, T Ntulo, M Nyatsanza, A Ofori-Atta, I Petersen, S Phakathi, M Prince, T Shibre, D.J.  Stein, L Swartz, G Thornicroft, M Tomlinson, L Wissow, E Susser, Epidemiology and Psychiatric Sciences. April 2015 DOI:10.1017/S2045796015000281
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Creating capabilities through maternal mental health Interventions: a case study at Hanover Park, Cape Town (2015)
I Meintjes, S Field, T Van Heyningen, S Honikman, Journal of International Development, 27, 234250 DOI: 10.1002/jid.3063
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Abuse in South African maternity settings is a disgrace: Potential solutions to the problem (Editorial) (2015)
S Honikman, S Fawcus, I Meintjes, The South African Medical Journal, April, Vol. 105, No. 4, 284 – 286.
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Patterns of use of a maternal mental health service in a low-resource antenatal setting in South Africa (2014) 
E Baron, S Field, Z Kafaar, S Honikman, Health and Social Care in the Community Journal doi: 10.1111/hsc.12167.
Weblink | PDF

The impact of antenatal mental distress on funtioning and capabilities: views of health care providers and service user in Cape Town, South Africa (2014) 
S Mall, S Honikman, B Evans, L Swartz, and C Lund, Informa Healthcare Disability and Rehabilitation: Vol. 36, No. 13, 1092-1099, doi:10.3109/09638288.2013.833300.
Weblink 

Maternal mental health care: refining the components in a South African setting in Global Mental Health (2014) S Field, E Baron, I Meintjes, T van Heyningen, S Honikman, chapter in Essentials of Global Mental Health, Cambridge University Press, 173-186.
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Screening and pathways to maternal mental health care in a South African antenatal setting (2013)
B Vythilingum, S Field, Z Kafaar, E Baron, DJ Stein, S Honikman, Archives of Women’s Mental Health, April, 1-9. doi: 10.1007/s00737-013-0343-1.
Weblink

Stepped Care for Maternal Mental Health: A Case Study of the Perinatal Mental Health Project in South Africa (2012) 
S Honikman, T van Heyningen, S Field, E Baron, M Tomlinson, PLoS Medicine, DOI: 10.1371/journal.pmed.1001222.
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Improving child outcomes through maternal mental health interventions (2010)
I Meintjes; S Field, L Sanders, T Van Heyningen, S Honikman, Journal of Child & Adolescent Mental Health, Vol. 22, No. 2, 73 – 82.
Weblink 

The Perinatal Mental Health Project (2004) 
S Honikman, H Rosenthal, S Faure, B Wirz, S van Zijl, M Littlejohn, N Bergman, S Fawcus, Mental Health Promotion: Case Studies from Countries, WHO/WFMH, (Eds. S Saxena & PJ Garrison), 84.
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Screening Tool development

ShortScreeningTool-PMHPThe PMHP identified a major obstacle to providing mental health care: the relevant mental health screening tool validated for our setting, the Edinburgh Postnatal Depression Scale (EPDS), does not address the context-specific needs of our health system. The EPDS has proven too cumbersome for routine use in busy antenatal clinics, and it is not sufficiently sensitive to a context challenged by HIV/AIDS, poverty, high rates of violence and trauma and a severe lack of social support within low-income communities.

The high prevalence of maternal depression in South Africa requires that maternal mental health screening, performed routinely and on-site, be logistically feasible and responsive to the local risk factors which may influence mental distress. To address this gap, we have developed a brief 5-question screening tool to identify symptoms of depression, anxiety and suicidal ideation.  

The study was based at our Hanover Park site. Women attending the maternity service were screened, offered counselling if required and referred to social support services where appropriate. Screening included the PMHP’s risk factor assessment, as well as several other risk and mood screens which are being assessed against a diagnostic gold standard. The most robust screening items were identified for inclusion in a valid, responsive and pragmatic new tool which may be used in limited-resource settings.

For more information read the Policy Brief here

Policy Briefs

Intimate Partner Violence (IPV) in South Africa: How to break the vicious cycle. 
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ShortScreeningTool-PMHP

Screening for common perinatal mental disorders in low-resource, primary care, antenatal settings in South Africa. 
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PRIME_PolicyBrief#5

Integrating maternal mental health into existing health and development programmes. 
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CPMH_PolicyBrief#1Integrating mental health into South Africa’s Primary Healthcare Re-engineering Plan.
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PMHP_PolicyBrief#15Maternal mental health: addressing key vulnerabilities. 
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PMHP_PolicyBrief#6

Integrating mental health into maternal care in South Africa. 
Download

 

Academic Presentations

2016

  • Maternal wellbeing and psychosocial support – First 1000 Days Plenary address
    Child Health Priorities Conference, Cape Town, South Africa  
  • Perinatal suicidal ideation and behaviour: psychiatry and adversity 
    World Psychiatric Association International Congress, Cape Town, South Africa
  • Prevalence and predictors of perinatal anxiety disorders amongst low income women in a resource poor setting 
    World Psychiatric Association International Congress, Cape Town, South Africa
  • Antenatal common mental disorders, suicidality and associated risk factors: a cross-sectional survey from a socially adverse setting, Cape Town 
    International Marcé Society for Perinatal Mental Health Conference, Melbourne, Australia
  • Nyamekela4Care – An integrated peer-support and training system for health and social care workers
    Rural Doctors Association of Southern Africa (RuDASA), Grahamstown, South Africa
  • Antenatal mental health disorders and associated risk factors: Evidence from a cross-sectional survey at Hanover Park MOU 
    35th Conference on Priorities in Perinatal Care in Southern Africa, Limpopo, South Africa
  • Integrating mental health in to maternal health care: promising results towards closing the treatment gap
    35th Conference on Priorities in Perinatal Care in Southern Africa, Limpopo, South Africa

2015

  • Department of Obstetrics and Gynaecology, University of Cape Town (UCT), Research Day (local presentation): Predictors of alcohol and other drug use among pregnant women in a low-income urban setting
  • Annual Symposium on Community Mental Health. Elizabeth Donkin Hospital – Port Elizabeth, South Africa – Maternal Mental Health – why and how we should respond.
  • Department of Psychiatry and Mental Health UCT, academic meeting (local presentation). Prevalence of antenatal depression and associated risk factors amongst low-income women living in Hanover Park. 

2014

  • International Marcé Society Biennial Scientific Meeting – SwanseaWales – Screening Tool development study 
  • World Congress of Psychiatry – Madrid, Spain – Symposium “Born this Way: finding solutions to global challenges in Perinatal Mental Health” – Maternal mental health and health service design

2013

  • Mental Health Research and Practice Development Conference – Mzuzu, Malawi – keynote address: Maternal mental health service development.

2012

  • Toward Carnegie III: Strategies to overcome Poverty and Inequality – University of Cape Town, South Africa – Creating capabilities through maternal mental health: a case study at Hanover Park.
  • Marcé Society Perinatal Mental Health Conference, Paris, France. – Integrating mental health care into maternity settings: lessons from a decade’s work in South Africa.
  • Perinatal Priorities Conference – Eastern Cape, South Africa – Maternal Mental Healthcare: Refining the components in a South African public health setting.
  • Western Cape Mental Health Summit – Cape Town, South Africa – Integrated mental health care: a cross-cutting solution.

2011

  • Paediatric AIDS Treatment for Africa Forum (PATA) – Gaborone, Botswana – Adolescent pregnancy, HIV and mental distress
  • Panel participant: Second Lancet Summit of the Movement for Global Mental Health – Cape Town, South Africa – Maternal mental health care: a model for integration
  • World Congress of the World Federation for Mental Health – Cape Town, South Africa – Symposium 1: Maternal mental health: from the clinical to the political, facilitated by PMHP Director

2010

  • Marcé Society Perinatal Mental Health Conference – Pittsburgh, USA – Mood changes in the Perinatal Mental Health Project.
  • South African Society of Psychiatrists Conference – South Africa – Maternal Mental Health: addressing key vulnerabilities.
  • African Health Facilities Conference – Durban, South Africa – Maternal mental health care: a model for integration.
  • National Department of Health Midwifery Summit – Johannesburg, South Africa – Maternal mental health care: a model for integration.

2009

  • Expanding our Horizons: Moving mental health and wellness promotion into the mainstream – Toronto, Canada – The ‘secret history’ method: training maternity staff for mental health promotion in Cape Town. Maternal antenatal distress: risk factors and service utilisation in a South African setting.
  • South African Society of Psychiatrists Conference – South Africa – Screening for psychological disorders in pregnancy in low-resource settings 
  • South African Development Community (SADC) Protocol on Gender and Development Ratification Seminar – South Africa – Putting maternal mental health on the agenda.
  • South African National AIDS Council working meeting of the NGO techincal task team – South Africa – Care for the caregiver and mental health protocols. 

2008

  • International Mental Health Conference – Institute of Psychiatry at The Maudsley, London, UK – The Perinatal Mental Health Project: A summative evaluation of a pilot implementation programme.
  • Paediatric AIDS Treatment for Africa (PATA) Conference – Kigali, Rwanda – Mental health considerations for mothers and caregivers of HIV positive children.

2006

  • UCT Department of Obstetrics and Gynaecology – Cape Town, South Africa – Perinatal Mental Health in Context at Postgraduate Refresher Course.

2004

  • Priorities in Perinatal Care in South Africa – Limpopo province, South Africa – The Perinatal Mental Health Project: an introduction.

PRogramme for Improving Mental health carE (PRIME)

PRIME is a consortium of research institutions and Ministries of Health in five countries in Asia and Africa (Ethiopia, India, Nepal, South Africa & Uganda), with partners in the UK and the World Health Organization. We collaborate with PRIME as a cross-country partner to generate research evidence on the implementation and scaling up of treatment programmes for priority mental disorders in primary and maternal health care contexts in low resource settings.

AFrica Focus on Intervention Research for Mental health (AFFIRM)

AFFIRM is a research and capacity development Hub established in 6 countries: South Africa, Ghana, Uganda, Zimbabwe, Malawi and Ethiopia. We collaborate with AFFIRM in their Randomised Control Trial (RCT) assessing a maternal mental health intervention delivered by community care workers in Khayelitsha, Cape Town.

Hosting postgraduate research

    Thandi van Heyningen

    Thandi is a Clinical Psychologist and researcher who is registered for a PHD at the University of Cape Town, School of Public Health & Family Medicine. Her work is based on the PMHP’s screening tool development study at Hanover Park. 

       

      Research opportunities at the PMHP

      Opportunities exist for the PMHP to host graduate students undertaking Masters or Doctoral studies engaging in high quality research of mutual interest in a range of disciplines such as anthropology, disability studies, psychiatry, psychology or economics.

      Interested applicants can contact us with a brief description of research interests or proposal concepts. Selected individuals will be mentored by experienced staff within the Department who will, where possible, assist in facilitating the procurement of funding as well as the necessary logistical procedures for the work to take place.

      Examples of previously hosted research

      • Motherhood and emotional distress in a South African township: an ethnographic investigation of postnatal depression in sociocultural context. (PhD)
      • A qualitative investigation of depressed mothers’ experiences with respect to functioning and participation. (Post-doc)
      • Barriers to accessing maternal mental health care. (Honours)
      • Formative work towards the development of a group-based intervention for vulnerable mothers.

      Overall Programme Objectives

      • Apply research findings and lessons through our government and non-government partner organisations to deliver mental health services to women.
      • Inform maternal mental health research and policy at all levels through dissemination of research findings.
      • Support/enhance the sustainability of the PMHP operations and maternal mental health services through direct application of research findings to service sites.
      • Produce peer reviewed publications.