In response to Daily Maverick article: “Antidepressants during pregnancy linked to autism in kids: study”
We would like to take the opportunity to raise caution with regard to the article published in The Daily Maverick titled “Antidepressants during pregnancy linked to autism in kids: study” on 20 July 2017
“Single studies like this need to be interpreted with great caution. Risk does not mean an inevitable outcome. Furthermore, an association does not necessarily mean cause. An association may reflect a causal link between autism and severe depression or the association may reflect a causal link between the medication and autism.
The global evidence is increasingly showing that the risk of untreated depression or anxiety perinatally on the foetus and infant, are likely to outweigh the risks of antidepressants on offspring outcomes. Balancing the risks is an important part of the decision to treat with antidepressants or not. This decision needs to be individualized and made collaboratively, as part of the consultation between the woman and her practitioner.”
Dr Simone Honikman, Perinatal Mental Health Project (PMHP)
The article is published here
Further information on antidepressant use during pregnancy in our Issue Brief
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?
Do you have a safety plan in place for you and your baby should anything go wrong?
Find out more about all this important information in our Violence against Women leaflet
Looking for more information for new mothers? Check out our resource pages.
Perinatal depression and anxiety are serious mental health problems and are among the leading causes of maternal morbidity and mortality worldwide!
Pregnant women are at higher risk for suicidal ideation and behaviours compared to the general population.
Suicide has been identified as one of the major contributors to the global mortality burden and there is a growing concern over the increase in suicidal ideation and behaviour among pregnant women.
Studies in low- and middle-income countries put the rate of maternal death due to suicide at somewhere between 0.65% and 3.55%. In such cases, risk factors include poverty, lack of support, lack of trust in health systems and coexisting mental illnesses.
Suicidal thoughts experienced during pregnancy can continue beyond the initial postpartum period, affecting the well-being of both mother and child.
More about pregnancy and suicidal ideation in our infographic
Improved detection and treatment of perinatal depression can contribute to reduction in maternal mortality
New research from Ethiopia suggests that improved detection and treatment of antenatal depression has the potential to increase planned institutional delivery and reduce perinatal complications.
Thus contributing to a reduction in maternal morbidity and mortality as well as improved neonatal health.
Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on the use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with the use of maternal health care services.
Read the full paper here
Find this and more latest research paper on our website:
Resources for researchers
The negative cycle of mental ill-health and poverty is particularly relevant for women and their infants during the perinatal period. During this time, major life transitions render women more vulnerable to mental illness from social, economic and gender-based perspectives.
Those with the most need for mental health support, have the least access. Overburdened maternal and mental health services have not been able to address adequately this significant unmet need. There have been limited attempts at a programmatic level, to integrate mental health care within maternal care services.
The perinatal period, where women are accessing health services for their obstetric care, presents a unique opportunity to intervene in the event of mental distress. Preventive work involving screening and counselling may have far-reaching impact for women, their offspring and future generations.
Mental health care is a notoriously neglected area – even more so in “healthy” pregnant and postnatal women. The focus on the physical to the detriment of the emotional is particularly felt now against the backdrop of HIV and AIDS. The public health service has been unable to address the mental health needs of women from poorer communities – neither within maternity services nor within mental health services. This is despite a wide body of evidence showing that distress in the mother may have long-lasting physical, cognitive and emotional effects on her children.
The PMHP aims to integrate mental health service routinely, within the primary maternal care environment.
Based at selected government MoU facilities in Cape Town, we offer counselling and support services focused on the emotional wellbeing of pregnant women with a strong focus on postnatal and clinical depression.
A recent systematic review and metanalysis reported that psychological treatments for common mental disorders in a range of primary care settings in LMIC, and delivered by non-specialist providers, had moderate to strong effects in reducing the burden of these disorders. Notably, 12 out of the 27 eligible randomized controlled trials took place in maternal or reproductive service settings.
A key finding relates to the analsysis of ‘nonspecific’ therapeutic elements, called ‘engagement elements’ which includes collaboration, empathy, active listening, normalization, Involving significant other/family. These elements predicted trial effectiveness independently of and comparably to specific elements, e.g. interpersonal, cognitive and behavioural (Singla et al. 2017). This provides critical support to PMHP’s hypothesis that maternity care staff may meaningfully employ empathic engagement skills to reduce the effects of common mental disorders in their clients.
Find this and more relevant research here: http://pmhp.za.org/resources/for-researchers/
The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarise existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development.
Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child’s emotional and behavioural development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited.
A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders to a broader family perspective with the focus firmly on parent-infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.
The full research review is available on Wiley Online Library
In our resource library, you can find information for future fathers in four different languages
Want to know how the Maternal Mental Health awareness campaign went this year?
Or want to check out our latest resources and developments in and around the PMHP?
Read our latest newsletter here
“As we celebrate International Day of Action for Women’s Health on May 28, we reflect on the physical, emotional and psychosocial dimensions of women’s health as well as the reasons to support girls’ and women’s health throughout the lifecycle.
With Sustainable Development Goal (SDG) 5 calling for an end to all forms of discrimination against all women and girls everywhere, the elimination of all violence against women and girls and universal access to sexual and reproductive health and rights by 2030, now is the time to draw attention to the many elements of and impediments to women’s health and rights […]
Emerging evidence suggests that integrated approaches to mental health can help to support improved performance across the wider health system.
- Knowledge and skills around psychology and mental health are important features of integrated care, whatever the client group.
- Despite this, the level of priority given to mental health in the development of new models of care has not always been sufficiently high.
- Some areas report that new models of care have made it easier for local professionals to obtain informal advice from mental health professionals without making a referral, creating a more seamless experience for patients.
- Working closely with voluntary sector organisations has allowed integrated care teams in some vanguard sites to better support the mental health and wellbeing of people with complex needs.
- Testing the mental health components of existing vanguard sites must be a central part of the evaluation strategy for the new care models.
- Other local areas rolling out multispecialty community providers, primary and acute care systems and related care models should go further than the vanguard sites in four key areas:
- complex needs: enabling local integrated care teams to draw on and incorporate mental health expertise to support people with complex care needs
- long-term care: equipping primary care teams to address the wide range of mental health needs in general practice (including among people presenting primarily with physical symptoms)
- urgent care: strengthening mental health support for people using A&E departments and other forms of emergency care
- whole-population health: placing greater emphasis on promoting positive mental wellbeing in the population, in particular among children and young people, and during and after pregnancy.
- All sustainability and transformation plans should set out ambitious but credible plans for improving mental health and integrating mental health into new models of care.
Source: The King’s Fund