Integrating perinatal mental health into primary health care in Belize

To describe the process and initial program outcomes of integrating perinatal mental health into maternal and child health services in Belize.

This was an exploratory study using both qualitative and quantitative methods. The qualitative data was extracted from project reports that described the process involved in the integration of mental health into primary health care facilities. The quantitative data was collected through a retrospective review of records of patients screened for perinatal mental health in 16 primary health care facilities from July to December 2024.

The results were organized into two sections. The first comprised the process for integrating perinatal mental health into maternal health services, which included training of primary maternal health care providers, development of Standard Operating Procedures on the use of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool and for referral protocols, and supportive supervision and monitoring. The second was the program outcomes, which included 485 pregnant women and adolescents who were screened and of whom 162 (33.4%) had an EPDS score of 12 or greater. All 23 (26.1%) adolescents and 139 (35.0%) adults with a positive screening were referred for mental health evaluation. Of those referred, only 59 (36.4%) were evaluated, and 27 (45.8%) were diagnosed with a mental health disorder. Of the 27 diagnosed, 19 (32.2%) were confirmed to be experiencing a depressive episode, the rate of which was significantly higher among adolescents: 5 (62.5%) compared with 14 (27.5%) adults (P < .05).

The findings of this exploratory study indicate that within the existing health system in Belize, the integration of perinatal mental health into maternal health care at the primary health care level is feasible and essential, particularly for identifying high-risk groups such as adolescents. It is imperative to improve uptake of mental health referrals for evaluation and treatment after screening.