Blog Archives

Many reasons to say Thank You

happy holidays from the PMHP

In our last newsletter of the year we’ve thanked you, our supporters, families and friends who believed in the work we do and supported us throughout 2016.

With your donation of expertise and money we were able to care for mothers in need and engage with those providing health and social support for them.

Enjoy this festive season and we are looking forward to an even more exciting 2017 with you!

In this newsletter we are highlighting some of the achievements of the previous two months. Happy reading.

perinatalmentalhealth_news

One in three migrant women from low- and middle-income countries has symptoms of perinatal depression

Migration and perinatal mental health in women from low- and middle-income countries.

In this systematic review and meta-analysis the authors summarising the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC).

Even though they found that the prevalence of perinatal depression is very high among migrant women, the data they found was insufficient to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population.

Furthermore the authors stress, that given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority.

Read the abstract in the BJOG – International Journal of Obstetrics and Gynaeocology

migrant_women_mental_health

Interested in mental illness among displaced, migrant and refugee women in South Africa? Read our Issue Brief

Why we should care about maternal mental health

Empathic engagement with mothers

Image: Graeme Arendse

When I examined Johanna*, I noticed that Johanna was very quiet during the examination. Although everything was fine with the pregnancy, I knew that something was wrong. Johanna had filled in a mental health screening questionnaire, which is routinely offered in our clinic. She had a high score. When I approached Johanna to offer a referral to the PMHP counsellor, she started crying. When I asked what was wrong, Johanna said I can’t talk about it. She did, however, want to see a counsellor.

This is only one of many stories we hear from our nurses and midwifes at at one of our service sites. So why is it important that we train health and social workers and advocate for routine mental health screening in all maternity units in the country?

Read about Johanna’s way out of an abusive relationship and how the counselling empowered her to seek help here

What is perinatal mental health?

Some people may be confused about some of the words used in relation to maternal mental health, like ‘intrapartum’, post-partum’, ‘ante-natal’, ‘post-natal’. The time during pregnancy, may be called the ‘antenatal’ or ‘prenatal’ period. ‘Postnatal’ refers to the time after birth. In the mental health field, postnatal may refer to 6 months or 12 months after the birth. Intrapartum usually refers to the labour and delivery time. ‘Perinatal’ refers to the time from the beginning of pregnancy to the end of the first year after the birth.

It is important not to confuse the ‘baby blues’ with postnatal depression. The ‘baby blues’ occurs in about 60-70% of mothers. Feelings of being overwhelmed and tearfulness occur on the third or fourth day after the birth and these resolve usually within a week. Depression or anxiety are more serious conditions and usually require some form of treatment. Depression or anxiety may occur during pregnancy, after pregnancy or in both time periods. The symptoms of these conditions may be confused with the usual physical symptoms of pregnancy such as sleep and appetite changes, aches and pains, tiredness or changing emotions. However, depression and anxiety affects a person’s mood, thoughts and how they function in most areas of their lives.

‘Psychosis’ is when a person becomes out of touch with reality. Postpartum psychosis is actually rare. It occurs in about 1 in every 1000 women (0.1%) who have a baby. This illness, if rapidly and effectively managed, usually resolves completely so that mothers may return to being well and fully functional.

Find more definitions on perinatal mood disorder here

Why should we care about it?

Perinatal depression and anxiety are significant mental and public health problems with well-documented consequences for mothers, children, and families. In developed countries, suicide is a leading cause of maternal death.

Because of the stigma of mental illness and a lack of understanding, many women who suffer from depression and anxiety, and their families, are not aware that these conditions require treatment (like any other health condition) and that they can be managed (often with relatively simple methods) so that they can recover fully.

Mental health care usually starts with some form of ‘talking therapy’. This can provide the necessary support to empower a women to identify resources and personal capabilities. A therapeutic relationship can enhance a woman’s resilience to difficult life circumstances and support her to nurture her children optimally. Caring for mothers is thus a positive intervention for long-term social development. Many women may also safely benefit from antidepressant medication which effectively treat both depression and anxiety.

How many are affected?

According to the World Health Organisation, worldwide about 10% of pregnant women and 13% of women who have just given birth, experience a mental disorder, mainly depression. In developing countries this is even higher, i.e. 16% during pregnancy and 20% after child birth.

In South Africa, studies show that at least one in every five women suffering during or after pregnancy.

1 in 5 women suffering from depression

Why is mental illness during and after pregnancy so common in South Africa?

Pregnancy and the postnatal period is a psychologically distressing time for many women, particularly for those living in poverty, or with violence, abuse, HIV/AIDS or an unintended pregnancy. Many women in South Africa live in these circumstances.

Several studies on prevalence of common perinatal mental disorders in low and middle income countries are collated on our website.

Who is at risk?

Infographic: Anisha Gururaj and Ashley Pople

Perinatal mental health is connected to a wide range of issues faced by women and although many of the risk factors are common for all women, they can vary from country to country. See the infographic below for comparative risk factors between India and South Africa.

Women in South Africa are particularly at risk when faced by:

  • Domestic violence – violence contributes to poor mental health, and poor mental health makes it more difficult for women to negotiate relationships where there is conflict
  • HIV/AIDS– HIV puts people at greater risk of mental health difficulties, while poor mental health makes it less likely that those who are HIV positive to adhere to treatment
  • Refugee issues– women who are refugees are more likely to suffer mental health difficulties due to their past experiences and to a current lack of support
  • Substance abuse – poor mental health makes women more likely to use substances such as alcohol in an attempt to feel better, but in turn, these substances and the circumstances around using them, lead to worse mental health
  • Teen pregnancy – teenagers with poor mental health are more likely to engage in risky behavior and become pregnant, while pregnancy brings increased social and emotional pressures which then affect mental health

What can we do about it?

Education is key and it is important that mothers and families are sensitized. Informing mothers about perinatal mental health will go a long way in helping them manage depression, anxiety and related illnesses. This education must include information about how to get help and support.

The support may be emotional, practical or financial. Partners should pay attention to the needs of the mothers as well as their own mental health. Seeking help when it is necessary for either or both parents, is a useful way to cope with difficult circumstances. This may be from family, community, health or social workers or faith-based organisations.

Find out where you can receive help in South Africa here

*The PMHP is committed to client confidentiality in keeping with the ethical requirements of professional mental health practice. The client stories reflect common scenarios or sets of circumstances faced by many of our clients. Pseudonyms are used and details are changed. The stories are not based on any one particular woman’s experience, unless an individual explicitly chooses to share her story with or without her name attached.  

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

New PMH Toolkit offers diverse collection of resources

The Royal College of General Practitioners has launched a new
Perinatal Mental Health Toolkit

The resources are designed to support GPs and healthcare professionals to support and deliver the care patients with perinatal mental health conditions need.

Furthermore it contains resources for mothers, fathers and an entire section on family support, self-care and well-being during and after pregnancy. This includes information leaflets for patients, and links to supporting charities and social media groups.

CaringForFuture

This toolkit offers a comprehensive and holistic approach to tackle the stigma of perinatal mental health problems!

To screen or not to screen

Screening is the entry point to mental health care.

We recently produced an advisory for primary level screening of mothers for depression, anxiety and suicidal ideation and behaviour in South Africa.

When health providers are not necessarily skilled in other forms of detection and when disorders are not clinically obvious, brief screening is a critical step towards providing mental health support for vulnerable women.

MMH_screening

Read the recommendations on our website.

Another recent study found that women who underwent regular maternal depression screening are more likely to avail of mental healthcare services before, during and after pregnancy.

Read this related article Maternal Depression Screening Is Causing More Women To Avail Of Mental Healthcare Services
in the Parent Herald

Mom and Mind Podcast on Maternal Mental Health

New podcast series focuses on mental health aspects of becoming pregnant, being pregnant and early parenthood.

In this podcasts Dr Kat is telling real stories from moms and family members who made it from struggling to wellness. She also interviews experts and advocates who work for moms and families to get the help they need.

One of these experts and mom who made it from struggling to wellness is the amazing Dr Wendy Davis. She shares her story about being a specialist and not realising she was suffering from postpartum depression.
“It’s like being in the middle of an earthquake and being a geo physicist, who studies earthquakes, and not knowing it’s an earthquake. That would be terrifying.”

Mom and Mind

Download past episodes or subscribe to future episodes of Mom & Mind Podcast for free on iTunes: Mom & Mind Podcast With Dr. Kat

Maternal Mental Health book for doctors, nurses and social workers.. Get your copy today!

The South African Psychiatry has featured our Maternal Mental Health Book prominently in their latest magazine.

Check the announcement on page 41 below.Bettercare add in SA Psych May15-3

You can also read or order a copy online on the bettercare website here

Mental Health is very often a stepchild to health – No Health without Mental Health

Essentials of Global Mental Health

“Global Mental Health is a newcomer to the global health movement”

Dr Samuel O. Okpaku is giving an insight into the global mental health movement in this video

We are proud to have contributed to this great book (check out chapter 19 on our website)

About the book

Mental illness accounts directly for 14% of the global burden of disease and significantly more indirectly, and recent reports recognise the need to expand and improve mental health delivery on a global basis, especially in low and middle income countries.

This text defines an approach to mental healthcare focused on the provision of evidence-based, cost-effective treatments, founded on the principles of sharing the best information about common problems and achieving international equity in coverage, options and outcomes. The coverage spans a diverse range of topics and defines five priority areas for the field. These embrace the domains of global advocacy, systems of development, research progress, capacity building, and monitoring.

The book concludes by defining the steps to achieving equality of care globally. This is essential reading for policy makers, administrators, economists and mental health care professionals, and those from the allied professions of sociology, anthropology, international politics and foreign policy.

Book cover

A year in review and other news from the PMHP

Hot off the press!

In the past year, our team has increased service, training and research outputs, retained quality and drove a range of exiting new activities.

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 For a full review of 2014 read our latest operational and financial report here

Also in the news this month:

– we published a Maternal Mental Health text book with Bettercare

– we released our Clinical Services Outcomes report

– we trained Social Workers

Read more in our latest newsletter here

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