Matter project: A system-wide initiative for early identification and intervention in perinatal mental health

Abstract

Objective: Perinatal mental health disorders affect up to 30% of women and are a significant public health challenge with long-term implications for mothers, infants, and communities. In Portugal, despite increased awareness, routine screening and coordinated referral systems remain limited. The Ma(t)ter project aimed to implement and evaluate a region-wide program in Central Alentejo to strengthen early identification and care coordination through systematic screening, cross-sector training, and digital innovation. Methods: The intervention included four components: implementation of automated screening at four perinatal timepoints (first and second trimesters, early and late postpartum), integrated into the national primary care software (SClínico); cross-sector training of health and social professionals, including a universitycertified microcredential; monthly multidisciplinary case review meetings; and development of an online platform to support clinical decision-making and interprofessional communication. Implementation outcomes were evaluated using mixed methods, including quantitative indicators (screening rates, referral patterns, professional engagement) and qualitative interviews based on the Consolidated Framework for Implementation Research (CFIR). Results: By the time of submission, 819 automated screening invitations had been sent, with a 20% response rate. Although below optimal, this rate aligns with initial projections for unsolicited digital health interventions. Strategies to improve uptake include proactive engagement by primary care professionals and public awareness materials. Among respondents, 25.4% reported a history of mental illness, and 18% screened as intermediate or high risk. Dozens of professionals had been trained, and structured referral pathways had been established. Preliminary findings suggest improved capacity for early identification and collaboration across services. However, limitations include potential response bias, lack of a comparison group, and early-stage implementation. Conclusions: The Ma(t)ter project provides a promising, though preliminary, model for improving perinatal mental health care through integrated systems and digital tools. Further evaluation is ongoing to assess long-term impact and scalability.