Abstract
Peripartum severe mental disorders (PSMDs) encompass schizophrenia, affective psychosis, and psychotic and non-psychotic forms of bipolar disorders. PSMDs are well documented in high-income countries. However, much less is known about the prevalence of PSMDs in low- and middle-income countries (LMICs). The aim was to review the available literature systematically and estimate the prevalence of PSMDs among women in LMICs. We searched the Ovid MEDLINE, Embase, PsycINFO, CINAHL and Maternity and Infant Care databases systematically from the date of inception to Dec 31, 2020, for English-language publications with data on the prevalence of PSMDs among women in World Bank–defined LMICs. Selection of studies, extraction of data and assessment of study quality were each undertaken independently by at least two of the investigators. A total of five studies (completed in three countries spanning two continents) met the inclusion criteria. Five studies reported cumulative incidence of postpartum psychosis (ranging from 1.1 to 16.7 per 1000 births). We found no studies on the prevalence of severe mental disorder during pregnancy in these settings. Marked heterogeneity in methodology precluded meta-analysis. These findings indicate that PSMDs occur at a similar prevalence in low- and middle-income to high-income countries. However overall, there is a paucity of high-quality evidence from these settings. There is a need for rigorous studies with standardized methods to increase knowledge of the nature, prevalence, and determinants of PSMDs among women in resource-constrained LMICs to inform policies, service development, program planning and health professional training.
Highlights
Mental health problems experienced by women who are pregnant or who have recently given birth are common
Most of the evidence about the prevalence of postpartum psychosis has been generated in World Bank–defined high-income countries (HIC) (Kendell et al 1987; Terp and Mortensen 1998; Munk-Olsen et al 2006; Vesga-López et al 2008; Valdimarsdottir et al 2009; Martin et al 2016)
One study (Bang et al 2004) recruited participants from a community-based population. In total these five studies reported on 167 women with a Peripartum severe mental disorders (PSMDs)
Summary
Mental health problems experienced by women who are pregnant or who have recently given birth (often referred to as the peripartum period) are common. These disorders contribute significantly to maternal morbidity and mortality, PSMDs can be pre-existing with onset before or during pregnancy or after childbirth (Jones et al 2014). The prevalence of postpartum psychosis is consistently estimated to be 1–2 per 1000 women who have recently given birth (Kendell et al 1987; Perry et al 2021). Establishing the true incidence and prevalence of an uncommon condition like postpartum psychosis is difficult, considering the relative rarity of the condition and the methodological challenges including need for assessment of very large samples and the logistical difficulties and costs associated with adequately sized prospective cohort studies. Two were from World Bank–defined low- and middleincome countries (LMICs)
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