Behavioral recurrence mechanisms of "pain shadow memory" and nursing intervention opportunities in postherpetic neuralgia during the skin lesion regression stage.

Perinatal mental illness (PMI), defined as psychiatric disorders such as prenatal and postpartum depression and anxiety disorders occurring during pregnancy and about 1 year after delivery (), represents a major public health threat globally (). Approximately 11% of women experience perinatal depression, with those in low-resource settings reporting higher rates (13.1% vs. 11.4%) compared with their counterparts in high-income countries (). African-specific data revealed a disturbing prevalence of prenatal depressive symptoms from 22.8% to 26.3% (, ). Relating to Ghana, the burden of antepartum depressive symptoms ranges from 19.7% to 50.5% (–), whereas postpartum depression was reported by 7% to 50.4% women (, ). Psychotic-like symptoms have also been documented among pregnant women in Ghana (). PMI has been implicated in adverse birth experiences and outcomes such as prolonged labour, postpartum complications, preterm birth, low birth weight, and caesarean section (–). The foregoing provides enough impetus to invite healthcare practitioners to play an active role in preventing PMI and improving women's perinatal mental health (PMH). Nurses and midwives constitute a critical mass of the healthcare workforce who are strategically positioned to identify and support women experiencing mental health challenges (), as well as reduce or prevent factors that contribute to PMI, such as anemia (). Nurses and midwives spend a considerable amount of time with pregnant and postpartum women, building rapport and trust that can be leveraged to inquire about and respond to PMH issues. Indeed, the Quality Maternal and Neonatal (QMNC) framework emphasizes a holistic approach to quality maternal care that also involves optimizing psychological processes to support woman's capabilities as part of the responsibilities of midwives and others working with pregnant and new mothers (). This is particularly important given the reluctance of women in the perinatal period to initiate and seek help on their own volition (, ). In response, several countries, including Ghana, have instituted reforms and programs to promote access to mental health services, such as the creation of dedicated mental health units across the various levels of care (). The QMNC framework recognizes the importance of sensitive and tailored maternal health service delivery that responds to the unique needs of childbearing women (). Some healthcare professionals have undergone Ghana Psychological Council certification programs in counseling to equip them with the requisite skills and knowledge to incorporate mental health services into primary, secondary, and tertiary healthcare delivery (). These initiatives are envisaged to increase the availability and accessibility of mental health services across the various spectrum of healthcare. However, our understanding of the current practices, capabilities, and challenges faced by nurses and midwives in promoting PMH remains very poor. Recent studies have concluded that several challenges continue to beset PMH services in Ghana and beyond (, ), but how these challenges influence mental health service provision to women remains less explored. Furthermore, while global guidelines emphasize the integration of mental health screening and support into routine maternal health care (), little is known about the various ways nurses and midwives have responded to this request. The current study expands the breadth of previous research by investigating existing practices, gaps, and strategies to promote PMH from the perspective of nurses and midwives in Ghana. Adopting an exploratory qualitative design with a needs assessment orientation, the study is analytically grounded in the QMNC framework, which positions psychosocial support, provider competence, and systems-level enablers as inseparable dimensions of quality maternal care. Consistent with the WHO health systems building blocks framework, which organises health system performance across the domains of service delivery, health workforce, information, medicines, financing, and governance, the study examines how these structural dimensions shape PMH care delivery at the frontline. The study is aimed at filling a critical void in the literature and, more crucially, to support the training, capacity-building, and policy development initiatives of nurses, midwives, and other healthcare professionals in PMH.