Closing the gap in maternal mental health care in #LMIC | Maternal Health Task Force

“A recent systematic review found that one in four women in low- and middle-income countries suffered from prenatal depression, and roughly one in five suffered from postpartum depression.

Additional efforts are needed to identify risk factors and develop culturally appropriate interventions to ensure that all women experiencing perinatal mental health issues are properly screened, diagnosed and treated.”

Source: Key Issues in Perinatal Mental Health | Maternal Health Task Force

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Poverty and mental illness

Poverty and mental health

A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy

“Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, require engagement with this complexity. […]

Although mental health problems can affect anyone at any time, they are not equally distributed and prevalence varies across social groups.”

Although this policy review is based on UK data it is relevant for everybody working in the mental health sector

 

 

Suicidal thoughts during pregnancy

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

Mental illness among displaced, migrant and refugee women

The United Nations High Commissioner for Refugees (UNHCR) estimates that there are currently 24.5 million refugees and asylum-seekers in the world (UNHCR 2015).

Depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease. Mental health among refugees is increasingly being discussed and researchers acknowledge:

Refugees are a vulnerable people.

We have found that uncertain refugee status is a key factor contributing to mental illness in pregnant women. Women with uncertain refugee status are particularly vulnerable to maternal mental illness. Psychological trauma, associated with political conflict, displacement, violence, loss of loved ones, torture, rape and poverty contribute to poorer general maternal health.

For more information see our Issue Brief and for a quick visual overview see our infographic below.

 

Local hunger and global collaborations

How hunger affects the mental health of pregnant mothers

2 out of every 10 South African families run out of money to buy food before the end of the month. Living in poverty is one of the factors increasing the risk of maternal mental illness. Find out why we believe, decreasing food insecurity is likely to improve the mental health of mothers and consequently increases the chances for our next generation to thrive?

This and more in our latest newsletter

Making a case for the integration of mental health screening into HIV care

Source: Journal of Interpersonal Violence

Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa

“Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. […]

Participants [of this study] almost unanimously agreed that it would be appropriate and acceptable to screen all women in the clinic setting for trauma and mental health symptoms. […]

The high prevalence of traumatic experiences and psychological distress in this study highlights an urgent need to integrate screening into routine HIV care. The study provides evidence of the acceptability of screening for trauma and mental health symptoms among HIV positive women, at the critical points of care engagement when they are initiating ART or have defaulted on ART. In addition, there is need to link women screened to interventions and services, as part of trauma informed HIV care.”

Full text available on Sage Journals

 

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

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?

 

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.

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

Breaking the negative cycle of mental ill-health and poverty during the perinatal period

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.

Integrating mental health into maternal care in South Africa

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.

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