Maternal mental health: program and policy implications (original) (raw)
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Preventing infant and child morbidity and mortality due to maternal depression
Best practice & research. Clinical obstetrics & gynaecology, 2016
This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary ...
BMC health services research, 2016
The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. Limited data were available at the district level, although generali...
Child Development Perspectives, 2009
Depressive disorders are a common source of disability among women. In addition to the economic and human costs of maternal depression, children of depressed mothers are at risk for health, developmental, and behav ioral problems. Although most of the research examining the evidence and intergenerational aspects of maternal depres sion has been conducted in high-income countries, recent evidence suggests that rates of maternal depression may be higher in low-and middle-income countries, where nearly 90% of the world's children live. This review examines the evidence from low-and middle-income countries that links maternal depression with children's health, development, and behavior. We present recommendations for future policies and intervention programs related to maternal depression and examine how maternal depression affects the rights of millions of children living in these countries. KEYWORDS-maternal depression; child; low-income coun tries; development Depressive disorders are common (Lepine, 2001), chronic (Pincus & Pettit, 2001), and a principal source of disability throughout the world, especially among women (Moussavi et al., 2007). Research from high-income countries 1 has documented that the economic and human costs of maternal depression are particularly insidious because they extend to the next generation, affecting children's health, development, and behavior. The symptoms that characterize maternal depression, including sadness, negative affect, loss of interest in daily activities, fatigue, difficulty thinking clearly, and bouts of withdrawal and intru siveness may interfere with consistent, attentive, and responsive caregiving, thereby disrupting effective parenting (Paulson, Dauber, & Leiferman, 2006). Infants are particularly vulnerable because they depend on their mothers for the primary interactions that form the basis of healthy attachment and timely acquisition of developmental skills (Coyl, Roggman, & Newland, 2002). We focus on the nature and consequences of maternal depression in low-and middle-income countries, where the majority of the world's children live. We examine whether the same intergenerational association between maternal depres sion and children's health, development, and behavior described in high-income countries exists in low-and middleincome countries. We also make recommendations for policies and intervention programs and examine how international children's rights policies are related to maternal depression. Given recent reviews on maternal depression in high-income countries (Flynn, 2005; Nylen, Moran, Franklin, & O'Hara, 2006; Sohr-Preston & Scaramella, 2006), our review of evidence from high-income countries is illustrative rather than systematic. MATERNAL DEPRESSION IN HIGH-INCOME COUNTRIES Studies from high-income countries have reported associa tions between maternal depression and disturbances in motherchild interactions (Lovejoy, Graczyk, O'Hare, & Neuman, 2000), negative perceptions of infant behavior (Foreman &
The lancet. Psychiatry, 2016
Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating ne...
2016
Common mental disorders such as anx-iety and depression are the third leading causes of disease burden globally for women between 14 and 44 years of age [1]. By 2030, these are expected to rise to first place, ranked above heart disease and road traffic injuries [2]. A recent systematic review reveals that maternal mental disor-ders are approximately three times more prevalent in low- and middle-income coun-tries (LMICs) than in high-income countries (HICs), where the related burden of disease estimates range between 5.2 % and 32.9% [3,4]. In HICs, maternal suicide is the leading cause of death during the perinatal
International Journal of Mental Health Systems, 2011
Mental health problems in women during pregnancy and after childbirth and their adverse consequences for child health and development have received sustained detailed attention in high-income countries. In contrast, evidence has only been generated more recently in resource-constrained settings. In June 2007 the United Nations Population Fund, the World Health Organization, the Key Centre for Women's Health in Society, a WHO Collaborating Centre for Women's Health and the Research and Training Centre for Community Development in Vietnam convened the first international expert meeting on maternal mental health and child health and development in resource-constrained settings. It aimed to appraise the evidence about the nature, prevalence and risks for common perinatal mental disorders in women; the consequences of these for child health and development and ameliorative strategies in these contexts. The substantial disparity in rates of perinatal mental disorders between women living in high-and low-income settings, suggests social rather than biological determinants. Risks in resource-constrained contexts include: poverty; crowded living situations; limited reproductive autonomy; unintended pregnancy; lack of empathy from the intimate partner; rigid gender stereotypes about responsibility for household work and infant care; family violence; poor physical health and discrimination. Development is adversely affected if infants lack day-to-day interactions with a caregiver who can interpret their cues, and respond effectively. Women with compromised mental health are less able to provide sensitive, responsive infant care. In resource-constrained settings infants whose mothers are depressed are less likely to thrive and to receive optimal care than those whose mothers are well. The meeting outcome is the Hanoi Expert Statement (Additional file 1). It argues that the Millennium Development Goals to improve maternal health, reduce child mortality, promote gender equality and empower women, achieve universal primary education and eradicate extreme poverty and hunger cannot be attained without a specific focus on women's mental health. It was co-signed by the international expert group; relevant WHO and UNFPA departmental representatives and international authorities. They concur that social rather than medical responses are required. Improvements in maternal mental health require a cross-sectoral response addressing poverty reduction, women's rights, social protection, violence prevention, education and gender in addition to health.
The study followed a prospective longitudinal approach with a randomized controlled design. A total 830 pregnant women were screened for depression using BEPDS and enrolled in the third trimester of pregnancy and 299 women with depressive symptom (36%) identified. Out of 299, 250 pregnant women aged between 15 and 40 years were randomly assigned into intervention and control group having 125 women in each arm. Women in the intervention group received the "Thinking Healthy (CBT based) program" at their home setting, from their last month of pregnancy till 10 months after delivery. Their children received psychosocial stimulation from birth till 10 months. Bangla version of Edinburgh Postnatal Depression Scale (BEPDS), Prenatal Attachment Inventory (PAI), Maternal Attachment Inventory (MAI), Bayley Scale of Infant Development-Third version (Bayley-III) and Family Care Indicator (FCI) were applied to get the outcome information. In addition, sever morbidity; breastfeeding, immunization, socioeconomic and demographic information were collected. Data were collected at three time points' viz. baseline, midline (6 months after delivery) and endline (12 months after delivery). There was no significant difference between any of the socioeconomic and demographic variables at baseline. EPDS at baseline was not different between the groups (p=0.419), but there was a significant improvement at midline (p=0.027) and at endline (p=0.024) between the groups following the intervention. Home stimulation was significantly different between the groups at 6 month (p=.023) and 12 months (p=0.010). There was no significant effect of the intervention on maternal depression after controlling the confounders. The differences in weight-forage and height-forage Z scores for infants in the two groups were not significant at 6 months (-0.84vs-0.99, p=0·4 and-1.4 vs-1.3, p=0·7 respectively) and 12 months (-0.99vs-1.1, p=0·7 and-1·41vs-1·56, p=0·4, respectively). The group difference in developmental outcomes of infants were significant at 6 months (p=.008, p=016, p=.004 for cognitive, motor and language development respectively) and at 12 months (p=0.002, p=0.065, p=0.022, p=0.000 for cognitive, motor, language and socio-emotional development respectively). After controlling the confounders the effect size of the intervention on cognitive and social emotional development were 0.36 and 0.45 respectively.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017
Background: Pregnancy is a major psychological, as well as physiological event; women may find themselves unable to cope with additional demands of pregnancy. Mental illness during pregnancy-whether anxiety, depression or more severe psychiatric disorders-can have a significant negative impact on a mother and her baby. Poor psychological health has been associated with low birth weight, premature birth, perinatal and infant death, postnatal depression, as well as long term behavioural and psychological impacts on the child. Depressive disorders are a common source of disability among women. Mental health problems during pregnancy and postpartum periods are one of the alarming health issue among women. Community-based epidemiological data on antenatal depression from developing countries is scarce. This study was conducted to assess the mental health status of pregnant women attending antenatal clinic of tertiary care hospital, SKIMS, Srinagar (J and K). Methods: A cross sectional study was conducted over a period of six months from 1stSeptember 2016 to 28th February 2017 among randomly selected pregnant women attending antenatal clinic of tertiary care hospital, SKIMS, Srinagar. A total of 200 pregnant women formed the study subjects. Data was collected by interviewing the pregnant women using pre-designed, pre-tested, semi-structured questionnaire. Data was analysed using Statistical Programme for the social science (SPSS) version 19.0. Results: Amongst the study population, prevalence of depressive disorder was 26%. The depression was significantly increasing with advancing pregnancy and advancing age. Socioeconomic status and depression was associated statistically significant (p=0.024). Women with bad relationship with in laws had significantly more depression compared to those who had good relationship with in laws (P=0.0037). The association between parity and depressive disorder was statistically insignificant(P=0,7144). Conclusions: When we care for mother we care for two live and live without psychological consideration is completely materialistic. A depressive symptom occurs commonly during 2nd and 3rd trimester of pregnancy, drawing attention to a need to screen for depression during antenatal care. Maternal health policies, a priority in developing countries, must integrate maternal depression as a disorder of public health importance. Intervention should target women in the early antenatal period.