Addressing the Maternal Mental Health Diagnosis Gap through screening tools

Source: Maternal Health Task Force blog

Diagnosis gap in Low- and Middle-Income Countries (LMICs)

Despite contributing significantly to maternal deaths and unproductive life years, common perinatal mental disorders (CPMD) often go undetected among women in low-resource regions. This can mean that up to 80% of women remain untreated in such settings. Resource-constrained primary care centers, high patient volumes, lack of recognition by health workers as well as increased task shifting to semi-skilled health workers contribute to this treatment gap. In order to encourage timely identification of CPMD among mothers followed by referrals, antenatal care provision centers are a promising platform in LMICs due to the high level of touchpoints between expectant women and health systems. In South Africa, for example, a mother’s contact rate with any antenatal care facilities is quite high at approximately 91%. […]

Empathic engagement training

Lead author Thandi van Heyningen shares insight into progress and next steps for improving maternal mental health in low-resource settings:

“Where health system resources are scarce, one way of improving detection and improving access to treatment, is to integrate these services into existing, routine, primary health care services using a stepped care approach. Improving detection through routine antenatal screening may provide a vital first step, however there is a need to generate further evidence on the feasibility and acceptability of existing screening tools for use in such settings, and by non-specialist health care workers.”

Read the full paper “Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women” in the MHTF-PLOS collection on NCDs and maternal health
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How social factors drive up suicide rates among pregnant women

Source: The Conversation/ Perinatal Mental Health Project & Jason Bantjes

Pregnant women in South Africa who live in poor communities are more likely to consider or attempt suicide than the general population. That’s a key finding from a recent study we undertook at Hanover Park.

The research found 12% of pregnant women living in low-resource communities had thought of killing themselves during the previous month. In the same period, an additional 6% of pregnant women reported they had started to enact a suicide plan or attempted to end their lives. Rates of depression and anxiety were also found to be elevated among the pregnant women who took part in the study.

These findings mirror research about high rates of suicidal ideation and behaviour among pregnant women elsewhere in the world. A review of 17 studies in high- and low-income countries found the prevalence of suicidal ideation among pregnant and postpartum women ranged from 5% to 18%. Rates were higher among pregnant women living in low-income countries.

Our study’s most-significant finding was that more than half of the pregnant women who were at risk of suicide did not have a diagnosable depressive or anxiety disorder. Their suicide risk was also associated with lower socioeconomic status, food insecurity, intimate partner violence and a lack of social support.

This suggests suicidal ideation among pregnant women is about more than mental illness. Past studies suggest suicide and mental illness are strongly linked. Pregnant women who are depressed or have problems with anxiety are more likely to experience thoughts of death and engage in suicidal behaviour compared with other pregnant women.

But our research shows social and economic context may be a much more important contributor to suicide risk than previously thought.

Pernicious impact of adversity

The findings show the pernicious impact of socioeconomic adversity, interpersonal violence and lack of social support on pregnant women’s wellbeing.

We found pregnant women who are the victims of intimate partner violence are twice as likely to engage in suicidal behaviour compared to other pregnant women. Those who experience food insecurity – either they go hungry regularly or they have considerable trouble feeding themselves and their families – are almost four times more likely to report suicidal behaviour.

Pregnant women who are not in a relationship are also more likely than other pregnant women to experience suicidal thoughts and attempt suicide. And we found suicide risk decreases as pregnant women experience more social support.

These findings add to the growing body of evidence showing that sociocultural and economic factors are important risk factors for suicide. Suicidal ideation and behaviour are not simply a symptom of mental illness. Suicide can be a reaction to living in a particular context or facing stressful circumstances.

So, our research supports the idea that suicide risk should be assessed independently of – and in addition to – depression and anxiety among pregnant women.

Broader focus needed

This is an important nuance. Suicide prevention initiatives have traditionally focused narrowly on identifying and treating psychiatric illness. Our findings suggest they should more broadly include interventions that tackle socioeconomic factors and adversity.

Interventions that focus exclusively on psychiatric determinants of suicidal behaviour are unlikely to be effective. This is especially true in low-resource settings. Contributing factors include a scarcity of mental health resources and factors that adversely affect people’s lives.

More work still needs to be done to identify effective suicide prevention interventions for pregnant women living in adverse conditions. This requires more collaboration between different sectors. Policymakers also need to tackle social ills and find ways to increase the level of support for pregnant women and mothers of young babies.

How hunger affects the mental health of pregnant mothers

Source: The Conversation/ Perinatal Mental Health Project

The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affects a pregnant woman’s mental health is food insecurity. Being food insecure is when someone doesn’t have food or has the wrong kinds of food.

This is one of the key findings of our study, conducted in an impoverished community in Cape Town which is also regarded as one of the most violent in South Africa.

We set out to explore the factors that affected common mental health problems in pregnant women. These included intimate partner violence, unemployment and food insecurity. We found that women who don’t get enough to eat when they are pregnant face a high risk of developing mental illnesses like depression and anxiety during pregnancy and after giving birth. And they are likely to have suicidal thoughts during this time too.

Several studies have analysed antenatal depression and shown that there are higher rates of depression among mothers-to-be in low socio-economic settings.

The South African Government provides social grants to mothers who meet certain low-income criteria after the birth of their babies. But, based on our findings, we would argue that women should be eligible for poverty alleviation support while they are pregnant. This would benefit them physically and emotionally. Research from a range of developing countries shows that providing pregnancy support grants benefits mothers and their children.

Based on these findings, and our own research, our view is that mental well-being and food security policies should be rolled out together as part of an antenatal care package for women. This is important because managing the mental health of mothers’ can help children develop better.

Pressures of poverty

In South Africa more than 40% of the population lives below the poverty line. This means that many families in poor communities don’t have enough to eat, or don’t have access to healthy food.

Often the food they buy doesn’t last the entire month which means that they skip meals or eat less food because there isn’t money for more. Recent statistics show that two in every ten South African families run out of money for food before the end of the month.

Hanover Park has high rates of unemployment, alcohol and substance abuse, physical and sexual violence, child abuse and neglect.

Our research found that almost half the pregnant women attending the Hanover Park Midwife Obstetric Unit were food insecure.

In the group of nearly 400 pregnant women, about 22% were depressed while 23% had an anxiety disorder; about 10% of women had both common mental disorders. Moderate to high risk levels of suicidal thoughts or behaviours were present in 18%. Being food insecure more than doubled the chance of a pregnant women developing depression or an anxiety disorder and was very strongly associated with previously having attempted suicide.

We also found that many women who had had their second, third or fourth child and lived in families with minimal income felt overwhelmed and hopeless at the prospect of bringing another child into the world.

The consequences

There are both short and long-term consequences of untreated mental illness in pregnant mothers.

Women with mental illness may find it challenging to use optimally existing services, including health services. Untreated depression in pregnancy has also been shown to be linked to premature birth and low birth weight.

After giving birth, mothers may have difficulty caring for themselves or their babies. Pregnancy is a critical window of development for a baby. When women develop mental health problems during pregnancy and after birth it may affect this window. If a new mother isn’t able to connect emotionally with her baby, in some cases neglect, or even hostility towards the baby can follow. Breastfeeding may also be affected.

These all matter for the healthy development of a child. If they’re deprived of these inputs they can, in the longer term, develop social, emotional and behavioural problems.

Solving the problem

The first big challenge is that public health and social service systems need to be revamped. Public health systems are aimed at decreasing maternal mortality rates. They’re equipped to help pregnant women deal with challenges such as HIV, massive blood loss or high blood pressure. But mental disorders, which occurs in 20-40% of pregnant women living in poor communities, often go unattended.

Our view is that common mental health problems should be detected and managed in routine maternity care settings. Non-specialist care providers, who have been properly trained and supervised, could use brief screening tools to detect problems and provide onsite counselling to women who need it.

But helping mothers cope with mental illness also needs government intervention to ensure that they don’t go hungry. This may be addressed by a social grant that begins in the antenatal period. This is only likely to have a meaningful impact if it has all components – the social, the physical and the mental.

Domestic Violence against Women during and after pregnancy

Women are particularly vulnerable to domestic abuse during and after their pregnancy. 

Protect yourself and your baby – help is available!

It is important to know what kinds of behaviour is considered domestic abuse – it is not only physical or sexual harm. Did you know that domestic abuse can happen between any persons sharing a household – not only at the hands of your partner?

Domestic violence in period is associated w/adverse obstetric outcomes. If you are pregnant & experiencing our guide provides information on where to go and who to contact if you need support

 

 

Call on the United Nation to recognize World Maternal Mental Health Day

We signed the petition calling on the World Health Assembly and the UN WHO to officially recognize World Maternal Mental Health Day, to be commemorated annually on the first Wednesday of May.

 Just click on the link, read the brief letter, and fill in your name – that’s all it takes to sign the petition! Let’s convince the UN to declare World Maternal Mental Health Day as their 8th officially recognised Day internationally.

 

Sharing Knowledge – #StrongerTogether

In South Africa 1 in 3 women suffers from common mental disorders (depression and/or anxiety) during and after pregnancy. That is why maternal mental health is our priority!

What is the situation in your country? Data is sparse #MoreResearchNeeded in developing countries! Let’s share knowledge during #WMMHday

#maternalMHmatters

Our journey continues – 2017 in a nutshell

2017 has been, mostly, a successful year for the PMHP with some major achievements. We have seen our strategic model realised in concrete terms in many of the arenas where we work: we identify key service gaps, conduct research, develop policy and support widespread implementation by others.

Click the image to read our Annual Report 2017

Find the PDF version and previous reports on our website.

Lean, but still going strong!

We started the year with a new publication on the relation of food insecurity, poverty and depression in pregnant women.
This year, we will focus on our research and advocacy activities, while strengthening our collaboration with advocates and researchers around the globe.
We want to use this opportunity to thank our partners and donors for their unwavering support!!
More on that in our latest newsletter.

Non-Communicable Diseases and Maternal Health Around the Globe

To commemorate International Women’s Day PLOS ONE, in collaboration with the Maternal Health Task Force,  published this list of research – focusing on non-communicable illness such as depression or obesity during pregnancy and how it impacts women and their children.

Non-Communicable Diseases and Maternal Health Around the Globe

“Non-communicable diseases (NCDs) account for almost 65% of women’s deaths around the globe, and three-quarters of women’s deaths caused by NCDs occur in low- and middle-income countries. This collection […] aims to draw attention to issues surrounding non-communicable diseases, with a particular focus on risk factors and implications for reproductive or maternal health.”

Click on the image or follow this link to the “Non-Communicable Diseases and Maternal Health Around the Globe” collection.

The Good, the Sad and the Way Forward

 Dear colleagues, supporters, partners and friends of PMHP

2017 has mostly been a successful year for the PMHP with some major achievements. We have seen our strategic model realised in concrete terms in many of the arenas where we work: we identify key service gaps – conduct research – develop policy – support the widespread implementation by others.

Read the entire director’s summary and the reasons behind the closure of two of our service sites on our newsletter


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