Category Archives: Suicide

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.

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We need sustainable solutions to deal with mental health treatment gap

On World Mental Health Day many have thought about mental health status in their countries and the treatment gaps all over the world.

Our blog focuses on articles and statistics around mental health care and in particular around maternal mental health care globally and in low- and middle-income countries.

“Mental health matters because it affects everyone”

“Around 30% of women in low-income countries and 10-15% in high-income countries have a significant mental health problem during pregnancy and after childbirth. And yet most of these women never get diagnosed or receive any treatment” Maternal Mental Health-Global Challenge

“South Africa needs sustainable solutions to deal with its mental health treatment gap, delegates heard at a roundtable discussion ahead of World Mental Health Day (WMHD) – “Economy, Equality and Access to Mental Health Services” Close the mental health treatment gap

“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 affect 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.” How hunger affects the mental health of pregnant mothers


Image: Robin Hammond

“Lack of food security is driving depression, anxiety and suicidal behaviour in poor communities” How hunger erodes mental health

“From OCD to suicide and depression, these numbers will alarm you.” (South Africa focus) 10 Mental Health stats South Africa

“South African children may be affected by a myriad of traumas. According to the South African Journal of Psychiatry, children and adolescents can suffer from post-traumatic stress disorder (PTSD) after being exposed to a range of traumatic events.” Here’s how the Sesame Street’s Muppets help kids

“Crisis issue needs to be priority among developing nations” Mental health treatment a human right

“World Mental Health Day: the need for conversations on the subject in India is as strong as ever, because despite a start, not enough of them are taking place.” A poignant series of films relates the stories of people who fought and won

Sick link between hunger and mental health – linking food insecurity and mental health.

“Future actions should focus on better identification of people in vulnerable situations who may require specific support including people experiencing mental distress, early intervention and culturally appropriate mental health training for all frontline staff.” Mental health is not the problem, it’s the solution

“Children whose mothers are depressed during pregnancy have a small increased risk of depression in adulthood, according to a UK study.” Depression risk ‘starts in the womb’

“What more needs to be done to make mental health care a reality for people worldwide.” Making mental health a cultural priority

“Mental health needs a new narrative. citiesRISE is a global platform committed to transforming the state of mental health policy and practice in cities and beyond to meet the mental health needs of populations across the world.” citiesRISE new website

 

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

Perinatal depression and anxiety: Let’s talk about moms and dads in Africa

In low- and middle-income countries (LMICs), competing health priorities, civil conflict, and a lack of political will mean that expenditure on mental health is a fraction of that needed to meet the mental health care needs of the population.

For mothers, this treatment gap is most notable in regions where health agendas focus on maternal mortality indicators.

Source: Essentials of Global Mental Health

Who is at risk of perinatal mental health disorder?

Common mental disorders during pregnancy and in the first year after birth are associated with certain risk factors. These include poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use as well as low social support.

– Migration
– Violence and abuse
– Alcohol and drug use

In South Africa, there is a very high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls being pregnant at least once. When adolescent mothers suffer from depression, the likelihood of a subsequent teenage pregnancy nearly doubles.

SAsouthAfrica

– Teenage pregnancy
– HIV/AIDS

How to address maternal mental illness among economically disadvantaged parents? 

Integration of services!

Mothers in many settings are using maternal and child health services as well as social services. Thus, detection and access will increase if maternal health screening and services are integrated into these public care platforms.

How to implement a maternal mental health intervention in low-resource settings?

We are sharing our lessons learned in this learning brief. 

We have also developed a Service Development Guidelines which demonstrates how to develop a mental health intervention at your facility, even with limited resources.

Find more free & open access resources for professionals on our website

And what about dads?

Postnatal depression can affect dads too. Find out about common concerns for new dads and discover helpful tips on how they can become more involved. We compiled a leaflet with information that could help you be better prepared for what is happening. The leaflets are available in

EnglishisiXhosa • Afrikaans • French

We Need to Talk About Suicide Prevention in South Africa

Suicide prevention is a serious public health priority, globally and in South Africa (SA). The World Health Organization (WHO) estimates that annually 800 000 people die by suicide, with the number expected to rise to 1.53 million by 2020. For every completed suicide there are approximately 20 non-fatal suicide attempts.  As many as 75% of suicides occur in low and middle income countries.

Suicide-Post-Pic-1
Photo: Jean Gerber

In SA suicide accounts for 9.6% of all unnatural deaths and there is approximately one completed suicide every hour. Data from the National Injury and Mortality Surveillance System suggests that 80% of suicides in SA are male and the number of suicide deaths is highest among individuals of 15 to 29 years of age.

Read the full blog by Dr Jason Bantjes on our DignityInMind campaign site.

Suicide risks among pregnant women and new mothers

To mark World Suicide Prevention Day we’d like to focus on suicidal thoughts during the perinatal period

Mothers’ emotional needs can go undetected during the perinatal period where there is much attention on the baby and women often face multiple difficulties. Studies have shown that women at risk for suicide may be easier identified, by increasing screening of expectant and new mothers for major depression and conflicts with intimate partners. Thus care providers and family may be able to detect symptoms and signs of suicidal thoughts and possibly prevent further distress or the development of suicidal behaviour.

Symptoms and warning signs include 

– Talk of suicide or dying “If I died, would you miss me?” or “It would be better if I were not here or dead.”
– Depressive symptoms, including feelings of guilt, hopelessness or no sense of the future.
– Feeling isolated or wanting to be alone “No one understands me”.
– Obsessive thinking – thinking ‘too much’, especially about harming oneself or dying
– Giving things away (clothes, expensive gifts), “When I am gone, I want you to have this.”

Our recently produced Issue Brief deals with some of the risk factors and unearths some of the myths surrounding suicide during and after pregnancy.

Suicide during pregnancy - myths

Read this and other Issue Briefs on our website

#WSPD16 will be commemorated on 10 September
Join the conversation on Twitter with the hashtag #WSPD16

Suicide is a major contributor to global death rates and a leading cause of maternal deaths

Suicidal ideation during the perinatal period

Mothers’ emotional needs can go undetected during the perinatal period where there is much attention on the baby. We suggest care providers routinely ask questions about suicidality during mental health or physical health screening.

Our recently produced Issue Brief deals with some of the risk factors and unearths some of the myths surrounding suicide during pregnancy.

Suicide during pregnancy - myths

Read this and other Issue Briefs on our website

Ever wondered what is considered a suicidal thought, ideation, or gesture? Than read this Explanation of Suicidal Thinking In Plain Mama English by Postpartum Progress

 

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