Knowledge Generation

The PMHP generates knowledge to strengthen maternal mental health systems in low resource settings

We work in partnership with other researchers and research institutions to generate an evidence-base to strengthen maternal mental health systems in low resource settings.

Our research focus areas are developed from on-the-ground experience and aim to provide new knowledge that can be pragmatically applied. 

These include distribution and determinants of multiple aspects of maternal mental health such as depression, anxiety, suicidality, alcohol and substance abuse, food insecurity and domestic violence. 

Research Publications

The development of an ultra-short, maternal mental health screening tool in South Africa (2019)
T v Heyningen, L Myer, M Tomlinson, S Field, S Honikman, Global Mental Health
DOI: 10.1017/gmh.2019.21
Weblink 

The Secret History method and the development of an ethos of care: Preparing the maternity environment for integrating mental health care in South Africa (2019)
S Honikman, S Field, S Cooper, Transcultural Psychiatry
DOI: 10.1177/1363461519844640
Weblink 

Accessible continued professional development for maternal mental health (2019)
S Field, A Abrahams, D L Woods, R Turner, M N Onah, D K Kaura, S Honikman, African Journal of Primary Health Care and Family Medicine, 11(1), a1902 
DOI: 10.4102/phcfm. v11i1.1902
Weblink 

Characteristics of perinatal depression in rural central, India: a cross‑sectional study (2018)
S. D. Rathod, S Honikman, C Hanlon, R Shidhaye, International Journal of Mental Health Systems
DOI: 10.1186/s13033-018-0248-5
Weblink | PDF

Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study (2018)
S Field, M Onah, T v Heyningen, S Honikman, BMC Women’s Health
DOI: 10.1186/s12905-018-0612-2
Weblink | PDF

Partnerships in a Global Mental Health Research Programme—the Example of PRIME (2018)
E Breuer, C Hanlon, A Bhana, D Chisholm, M De Silva, A Fekadu, S Honikman, M Jordans, T Kathree, F Kigozi, NP Luitel, M Marx, G Medhin, V Murhar, S Ndyanabangi, V Patel,  I Petersen, M Prince, S Raja, SD Rathod, R Shidhaye, J Ssebunnya,  G Thornicroft,  M Tomlinson, T Wolde-Giorgis, C Lund Global Social Welfare 
DOI: 10.1007/s40609-018-0128-6
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Intercultural Adaptation of the “Secret History” Training: From South Africa to Germany (2018)
E Hänselmann, C Knapp, M Wirsching, S Honikman, Global Health Collaboration, Chapter 4
DOI: 10.1007/978-3-319-77685-9
Weblink | PDF

Adapting a perinatal empathic training method from South Africa to Germany From South Africa to Germany (2018)
C Knapp,  S Honikman, M Wirsching, G Husni-Pascha, E Hänselmann, Pilot and Feasibility Studies
DOI: 10.1186/s40814-018-0292-6
Weblink | PDF

Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women (2018)
T v Heyningen, S Honikman, M Tomlinson, S Field, L Myer, PLoS ONE 13(4): e0193697,
DOI: 10.1371/journal.pone.0193697
Weblink | PDF

Postpartum psychiatric disorders (2018)
S Meltzer-Brody, L M Howard, V Bergink, S Vigod, I Jones, T Munk-Olsen, S Honikman, J Milgrom, Nature Reviews Disease Primers
DOI: 10.1038/nrdp.2018.22
Weblink

Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study (2018)
Z Abrahams, C Lund, S Field, S Honikman, Social Psychiatry and Psychiatric Epidemiology
DOI: 10.1007/s00127-018-1497-y
Weblink | PDF

Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study (2017)
T v Heyningen, S Honikman, L Myer, M N Onah, S Field, M Tomlinson, Archives of Women’s Mental Health, 
DOI: 10.1007/s00737-017-0768-z
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Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia (2017)
T Bitew, C Hanlon, E Kebede, S Honikman, A Fekuda, BMC Psychiatry (2017) 17:301, 
DOI: 10.1186/s12888-017-1462-4
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‘First 1000 days’ health interventions in low- and middle-income countries: alignment of South African policies with high-quality evidence (2017)
R English, N Peer, S Honikman, A Tugendhaft, K J Hofman, Global Health Action, 10:1, 1340396, 
DOI: 10.1080/16549716.2017.1340396
Weblink | PDF

Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia (2017)
T Bitew, C HanlonE Kebede, S Honikman, M N Onah, A Fekadu, BMC Pregnancy and Childbirth BMC series; DOI: 10.1186/s12884-017-1383-8
Weblink | PDF

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
Weblink | PDF

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
Weblink | PDF

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
Weblink 

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
Weblink | PDF

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
Weblink | PDF

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
Weblink | PDF

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
Weblink | PDF

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.
Weblink | PDF

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
Weblink | PDF

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.
Weblink | PDF

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 

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.
Weblink 

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.
Weblink | PDF

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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  • Nyamekela4Care (N4C): The PMHP has formed a research partnership with the Children’s Institute (CI) to adapt and evaluate N4C for use with Child Protection service teams. Preparation for this evaluation is underway.

 

  • Nyamekela4Care (N4C): We have a research partnership with the Institute for Life Course Health Research at Stellenbosch University to evaluate N4C in Community Orientated Primary Care facilities in Mamre and Bishop Lavis. Baseline data collection was completed at the end of 2018. Mid-point assessments are due to be conducted in the second half of 2019.

 

  • KILKARI: This research project aims to evaluate two large scale mobile health (mHealth) initiatives in India, Kilkari and Mobile Academy providing messages for mothers and front-line workers in maternal and child health. The project is managed by The Johns Hopkins School of Public Health (JHU) and collaborates with BBC Media Action. Simone Honikman is a co-investigator.

 

  • ASSET is a National Institute for Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa. It is working in four countries; Ethiopia, South Africa, Sierra Leone and Zimbabwe. Simone Honikman is a co-investigator and supported this work through Theory of Change workshops, intervention development and protocol design for the intervention phase.

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 Overview of the study here

For more information read the Policy Brief here

Policy Briefs

Screening for Common Perinatal Mental Disorders in South Africa: The need, the research, the tool. Let’s do it.  Open | Research Poster | Open

 

 

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

 

 

ShortScreeningTool-PMHP

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

 

 

PRIME_PolicyBrief#5

Integrating maternal mental health into existing health and development programmes. 
Download

 

 

CPMH_PolicyBrief#1Integrating mental health into South Africa’s Primary Healthcare Re-engineering Plan.
Download

 

 

PMHP_PolicyBrief#15Maternal mental health: addressing key vulnerabilities. 
Download

 

 

PMHP_PolicyBrief#6

Integrating mental health into maternal care in South Africa. 
Download

 

Academic Presentations

2018

  • Maternal mental health intervention research in Africa – co-convenor of the symposium 
    International Marcé Society for Perinatal Mental Health Conference, Bengalaru, India
  • Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed-methods study – oral presentation
    International Marcé Society for Perinatal Mental Health Conference, Bengalaru, India
  • Development of a brief mental health screening tool for pregnant women in South Africa – oral presentation
    International Marcé Society for Perinatal Mental Health Conference, Bengalaru, India
  • Validation of a brief mental health screening tool for pregnant women in South Africa – poster presentation
    International Marcé Society for Perinatal Mental Health Conference, Bengalaru, India
  • Development of a brief screening tool for common perinatal mental disorders – oral presentation
    South Africa 35th Conference on Priorities in Perinatal Care in Southern Africa, Drakensberg, South Africa 
  • ‘Secret History’ workshop, a training method for enhancing providers’ empathic care for mothers 
    Global Mental Health Summit, Johannesburg, South Africa 

2017

  • Symptoms of depression and anxiety in pregnant women from low socio-economic settings improve after counselling
    Psychotherapy Symposium, UCT, Stellenbosch University, University of the Western Cape, Western Cape Health, Cape Town, South Africa
  • An overview of the PMHP maternal mental health service at Mowbray Maternity Hospital and outcomes from the last two years
    Department of Obstetrics and Gynaecology, Mowbray Maternity Hospital, Cape Town, South Africa
  • Economy, Equality & Access to Mental Health Services: Food insecurity and maternal mental health
    World Mental Health Day symposium, Baxter Theatre, Cape Town, South Africa

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.