RESPONSE Study Ghana: 5% of Pregnant Women Face Suicidal Ideation – Maternal Mental Health Crisis Exposed

Introduction

In a groundbreaking revelation from the RESPONSE research project, 5% of pregnant women and new mothers in Ghana—equivalent to 1 in 20—reported suicidal thoughts in the past month. This alarming statistic, unveiled during a national policy discussion on November 27 at the Ghana College of Physicians and Surgeons (GCPS), underscores a hidden perinatal mental health crisis demanding urgent integration into primary healthcare. Led by the London School of Hygiene & Tropical Medicine (LSHTM) in collaboration with the Ghana Health Service Research and Development Division (GHS RDD), the four-year study screened over 2,000 antenatal and postnatal women using the WHO’s Self-Reporting Questionnaire (SRQ-20). Funded by the UK Medical Research Council, Foreign Commonwealth & Development Office (FCDO), and Wellcome Trust, these findings highlight the need for scalable mental health screening in maternal care across Ghana.

What is the SRQ-20?

The SRQ-20 is a validated WHO tool designed to detect psychological distress in low-resource settings. It consists of 20 yes/no questions covering symptoms like anxiety, depression, and somatic complaints. A score of 6 or higher indicates significant distress, providing a reliable threshold for intervention in perinatal mental health assessments.

Analysis

The RESPONSE study’s comprehensive 42-month analysis, including a six-month pilot in six primary health facilities in Prampram-Ningo and Shai-Osudoku districts of Greater Accra, reveals the scale of maternal distress in Ghana. Overall, 28% of screened women scored 6 or above on the SRQ-20, signaling widespread psychological burden. Antenatal women showed higher distress at 36%, compared to 25% for postnatal women, challenging the traditional focus on postpartum depression alone.

Vulnerable Populations in Perinatal Mental Health

Certain groups face elevated risks. Among 172 adolescent mothers aged 14-19, 43% exhibited distress—nearly double the 27% rate for women aged 20 and older. Women who experienced pregnancy loss reported distress in 50% of cases. Professor Irene Agyepong, Co-Principal Investigator and Ghana Team Lead, emphasized: “Traditionally, we focus only on postpartum depression, but our data shows the problem often starts during pregnancy.” These insights point to systemic gaps in antenatal mental health support.

Health Worker Burnout: A Parallel Crisis

Frontline health workers are also under strain, with 51% reporting moderate to extremely severe anxiety, 40% stress, and 37% depression. This burnout exacerbates service delivery challenges, as noted by Prof. Tolib Mirzoev, Principal Investigator: “Health systems’ responsiveness is a critical aspect of performance. Prioritising responsiveness to both patients and staff, particularly in mental health, is essential.” Stigma further hinders help-seeking among providers and patients alike.

Summary

The RESPONSE project exposes a maternal mental health epidemic in Ghana, where perinatal distress affects 28% of women, suicidal ideation impacts 5%, and adolescents are disproportionately vulnerable. A piloted screening-to-referral model using SRQ-20 and WHO mhGAP-trained nurses proved feasible, linking primary care to specialists at facilities like Pantang Hospital. Policy discussions urge guideline revisions, dedicated funding, and National Health Insurance Scheme (NHIS) integration to scale solutions nationwide, while addressing health worker well-being.

Key Points

Practical Advice

Implementing effective perinatal mental health strategies requires actionable steps tailored to Ghana’s context. Primary health facilities should routinely administer the SRQ-20 during antenatal and postnatal visits. Women scoring ≥6 need immediate referral to mhGAP-trained mental health nurses for assessment.

Screening and Referral Pathway

1. Universal Screening: Integrate SRQ-20 into all maternal routine check-ups.
2. Nurse-Led Evaluation: Use WHO mhGAP protocols adapted for Ghana to diagnose and manage cases at primary level.
3. Escalation: Refer complex cases to psychologists or psychiatrists at tertiary centers.
4. Staff Support: Provide counseling and training for health workers to combat burnout.

For Expectant Mothers and Families

Recognize early signs of distress such as persistent sadness, anxiety, or sleep issues. Seek help promptly through local clinics. Community education can reduce stigma, encouraging open discussions about antenatal depression and postnatal mental health.

Policymakers should prioritize revising National Reproductive Health Guidelines to mandate screening, allocate budgets for mental health services, and explore NHIS coverage for sustainable financing.

Points of Caution

While the data is compelling, caution is needed in interpretation and rollout. High stigma in Ghanaian communities may deter women from disclosing symptoms, potentially underreporting true prevalence. Adolescent mothers and those with pregnancy loss require targeted, non-judgmental interventions to avoid alienating vulnerable groups.

Addressing Health Worker Strain

Neglecting provider mental health risks service collapse. Prof. Agyepong noted: “If you want us to care for patients’ mental health, you must first care for ours.” Mandatory wellness programs and anti-stigma training are essential before national scale-up.

Over-reliance on screening without follow-up infrastructure could lead to false positives or unaddressed referrals. Pilots succeeded in controlled settings; broader implementation demands robust monitoring.

Comparison

The RESPONSE study contrasts antenatal and postnatal distress, with pregnant women at 36% versus 25% for new mothers, indicating pregnancy as a critical risk window often overlooked. Adolescents (43%) far exceed adults (27%), underscoring age-related vulnerabilities. Compared to general populations in similar low-resource settings, Ghana’s 28% overall rate aligns with global perinatal mental health burdens but highlights local hotspots like pregnancy loss (50%). Health worker metrics—51% anxiety versus patient 28% distress—reveal caregivers bear a heavier load, inverting typical hierarchies.

Antenatal vs. Postnatal Distress

Legal Implications

While the RESPONSE findings are primarily policy-oriented, they intersect with Ghana’s legal framework for health rights. The National Health Insurance Scheme (NHIS) Act mandates equitable access to essential services; integrating maternal mental health screening could fulfill this by expanding covered interventions. Revised Reproductive Health Guidelines would align with constitutional health rights under Article 34, promoting universal health coverage. No direct legal violations are cited, but failure to act may hinder Sustainable Development Goal 3 (good health and well-being) commitments, prompting accountability through policy enforcement mechanisms.

Conclusion

The RESPONSE study’s exposure of 5% suicidal ideation among pregnant women in Ghana marks a pivotal moment for perinatal mental health. With 28% overall distress, heightened risks for adolescents and those with loss, and strained health workers, the path forward is clear: embed screening in primary care, support providers, and secure funding via NHIS. As Prof. Agyepong stated, “Maternal and health worker mental health is not a luxury—it is foundational to achieving universal health coverage and the Sustainable Development Goals.” A committed Technical Working Group now drives scale-up, turning evidence into enduring change.

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