Mentalni poremećaji u peripartalnom periodu

BackgroundThe perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable time, there is a high prevalence of depressive and anxiety disorders among pregnant women. In 2019, the Health Commission of Shenzhen initiated perinatal mental health screening programme in China. However, attitudes and perceptions of medical staff towards implementing mental health screening programme during pregnancy remain unclear. The aim of this study was to explore the perceptions and attitudes of obstetric staff and midwives towards screening for perinatal mental disorders in pregnant women, and identify their perceived needs and motivations for undertaking this task.MethodsThis is a qualitative exploratory study. Data were collected through in-depth, semi-structured, face-to-face interviews. The dataset was analysed using inductive content analysis. Purposive sampling method was used to recruit 13 participants at a tertiary maternal hospital in Shenzhen from September to November, 2019.ResultsA total of 13 obstetric staff was interviewed, including two obstetricians, three midwives, and eight nurses. Four themes were identified from this study: views on perinatal mental health disorders screening, competency in identifying and supporting high-risk groups, barriers to dealing with psychological problems during pregnancy, and the support needs of medical staff in undertaking the tasks of mental health disorders screening.ConclusionMedical staff lacked sufficient knowledge and skills in perinatal psychological health and were not well prepared for the task of screening pregnant women for mental health disorders. To address this issue, medical organisations and relevant government sectors should provide training to medical staff on perinatal mental health disorders, enhance public awareness of perinatal mental health disorders, establish a model of multidisciplinary collaboration for the screening of women’s perinatal mental disorders, and provide continuous and holistic care for pregnant women.

Prepregnancy Stressful Life Events and Perinatal Mental Health Disorders From Pregnancy to 3 Years After Childbirth: An Observational Study.

Perinatal mental health and the COVID-19 pandemic.

Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.

There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.

BackgroundThe perinatal period is a time of increased vulnerability regarding maternal mental health status. Although guidelines and policies have been published for perinatal mental health disorders (PMHDs) screening in China, the knowledge, attitudes, and support needs of nurses and midwives toward implementing mental health screening programs during pregnancy remain unclear. Thus, this study aimed to investigate the knowledge of PMHDs, attitudes and support needs related to implementing mental health screening during pregnancy among obstetrics and gynecology (OB/GYN) nurses and midwives in the central region of China while identifying the related influencing factors.MethodsA cross-sectional survey was conducted in 14 cities in Hubei, China, using convenience sampling from July to October 2023. The Chinese version of the Perinatal Mental Health Knowledge Questionnaire, the Chinese version of the Perinatal Mental Health Attitudes Scale, and the Health Care Facilities Support Needs Scale were used to investigate the PMHDs knowledge, attitudes, and support needs of OB/GYN nurses and midwives, respectively. Data were analyzed using SPSS version 27.0. Descriptive and inferential statistics were performed, with a p-value of <0.05 considered statistically significant.ResultsThe average scores for knowledge, attitudes, and support needs were 6.09 ± 1.99 (total score: 13), 47.67 ± 8.80 (total score: 80), and 29.35 ± 4.66 (total score: 35), respectively. After adjusting for years of nursing experience and years of obstetrics and gynecology nursing experience, the multivariate logistic regression analysis indicated that having mental health-related education or work experience [adjusted OR (aOR) = 1.43, p = 0.01], being midwives (aOR = 1.78, p < 0.001), and working in specialist maternity hospitals (aOR = 1.55, p < 0.001) were significantly associated with higher knowledge scores; having mental health related education or work experience (aOR = 1.59, p = 0.014) and working in specialist maternity hospitals (aOR = 1.42, p < 0.01) were significantly associated with higher support needs scores.ConclusionOB/GYN nurses and midwives demonstrated insufficient knowledge and moderate attitudes toward PMHDs screening, and have great support need for PMHDs screening. To address these issues, medical organizations and relevant government sectors should enhance training for nurses and midwives on PMHDs and provide professional support to promote routine maternal mental health screening programs and improve perinatal mental health outcomes.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

PROSPERO, CRD42019124057.

Addressing Maternal Mental Health: Progress, Challenges, and Potential Solutions

ABSTRACTBackground:Perinatal mental health disorders affect maternal and child health significantly. It can manifest as postpartum blues, postnatal depression or a more severe form as postpartum psychosis. Mostly, postpartum mental health disorders remain undiagnosed and untreated and there is paucity of data on the true prevalence of these disorders in the community.Methods:The present study has been conducted as a community-based cross-sectional study on postpartum and post-abortion women in the sub-Himalayan hilly area of India. The main objective of the study was to know the prevalence of perinatal mental health disorders and it’s risk factors in the community through structured questionnaires and interviews during the postpartum period. Edinburgh postnatal depression scale (EPDS) and Bebbington and Nayani questionnaire were used to screen for depression and postpartum psychosis, respectively.Results:A total of 526 eligible participants were screened, and the overall prevalence of perinatal mental health disorders in our study was 31% (163/525), with 16% (85/525) having postpartum blues and 15% (78/525) having postpartum depression. Among the obstetric factors, having a preterm delivery was found to be associated with increased chances of postpartum depression. (14% vs 8%, P = 0.250). None of the sociodemographic factors studied showed a significant association with postpartum depression.Conclusion:The study elaborates on the prevalence of perinatal mental illness in our community and various risk factors affecting the chances of women having these problems. Delivery of a preterm baby was found to be associated with increased chances of postpartum depression.Key message: Perinatal mental health is an important aspect of maternal and child health. Most perinatal mental problems remain undiagnosed and untreated, thus posing a serious hazard to maternal and neonatal health.

Perinatal mental health disorders are increasingly acknowledged as contributors to adverse maternal outcomes. We analyzed the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS; 2016 and 2017) to estimate hospitalization cost, length of stay, and severe maternal morbidity associated with perinatal mental health disorders overall, as well as stratified by payer and by specific mental health category. We found that individuals with mental health disorders had $458 higher costs per delivery hospitalization and 50% higher rates of severe maternal morbidity compared to those without mental health disorders. We estimate increased annual delivery hospitalization costs of $102 million in the US among individuals with perinatal mental health conditions compared to those without. Furthermore, individuals diagnosed with trauma/stress-related mental health disorders had even higher rates of hospitalization costs of $825 per delivery and 87% higher rates of severe maternal morbidity compared to those without. These findings provide important information for perinatal mental health program feasibility and cost-effectiveness analyses and suggest the need for increased focus on trauma/stress-related disorders.

With the pandemic of Coronavirus disease-19 (COVID-19) spiraling out of control, the world is desperately frazzled at the moment. A few empirical studies related to this pandemic have reported higher prevalence of mental health problems among women compared to men.1 In this context, pregnant women and new mothers could certainly be more vulnerable. Are there psychological repercussions of this outbreak on maternal health? Are perinatal maternal mental health disorders an inevitable burden of this pandemic? Could this be averted with a proactive, multidisciplinary, integrated health services approach targeting the vulnerable population of pregnant women? Although pregnancy is commonly believed to be a joyous time for most women, some women experience a range of negative emotions during pregnancy leading to anxiety and depression. Maternal mental health problems are associated with short-term and long-term risks for the affected mothers' overall health and functioning, as well as their children's physical, cognitive and psychological development. Conditions such as extreme stress, emergency and conflict situations, and natural disasters can inflate the risks of perinatal mental health morbidity. Therefore, it is plausible that pregnant women are vulnerable to mental ill-health during the COVID-19 pandemic. Several studies on COVID-19 and pregnancy have been published recently, but the impact of this pandemic on maternal mental health has not yet been properly evaluated. However, the importance of considering the possibility of increased risk to avoid adverse effects has been highlighted.2 The risk may be related to concerns regarding the wellbeing of the unborn child, but aggravated by unintended consequences of preventive measures, such as quarantine, physical distancing, home isolation, remote consultations with healthcare professionals, and inability to obtain expected level of support and care prenatally as well as during the intrapartum and postnatal periods. The World Health Organization and several professional societies of obstetricians and gynecologists have come up with guidelines in managing COVID-19 during pregnancy and delivery, but the recommendations vary due to lack of solid evidence.2 Although initial data from China suggested no increased risk of infection and morbidity among pregnant women compared to the general population,3 a different picture is emerging as the outbreak has escalated into a global pandemic. Pregnant women may be at risk of having more severe disease, preterm deliveries are more common, and maternal and neonatal mortalities have been reported.4, 5 Furthermore, risk of miscarriage associated with COVID-19 remains unclear although the presence of severe acute respiratory syndrome corona virus-2 (SARS-COV-2) in a second trimester placenta has been demonstrated.6 These uncertainties are likely to add to psychological stress and may even lead to increased rates of pregnancy terminations. As many hospitals have put restrictions on visits by partners and relatives to pregnant women admitted to hospitals for delivery, some women may choose to deliver at home. This could create a problem as availability of qualified birth attendants and midwives to support home deliveries is limited, even in affluent countries, and may lead to increased maternal and neonatal complications. Although transmission of SARS-COV-2 through breast milk is unlikely,7 some infected women may choose not to breast-feed temporarily to avoid direct contact with the newborn and reduce the risk of neonatal infection. However, such practices and early cessation of breastfeeding may contribute to poor health among mothers and infants.8 Strict public health measures directed towards mitigating the spread of disease are necessary, but known to have negative psychological effects leading to stress, anger and confusion.9 The prolonged pandemic chaos will inevitably have economic consequences, and financial uncertainties are likely to further escalate psychological burden and worsen the mental wellbeing of pregnant women and new mothers. Some individuals may resort to harmful methods of coping with the crisis, such as alcohol consumption and substance abuse, thus adding to existing mental health problems. This may also lead to an increase in gender-based intimate partner violence, reduction in preventive help seeking behavior, and increase in suicide rates with devastating results, especially among low-income families and immigrant communities. In this unprecedented time, every country in the world is struggling and trying its best to join forces to combat an unfamiliar disease. The importance of surveillance for emerging threats to pregnant women and infants during times of crisis cannot be overemphasized.10 However, mental health needs are currently overshadowed by other, more pressing issues in healthcare. It may take time to generate sufficient and sound evidence, but we can safely speculate that pregnant women are at increased risk of developing mental health problems such as depression, anxiety, and post-traumatic stress symptoms. There appears to be a substantial knowledge gap, but also a reluctance to accept that the psychological wellbeing of pregnant women is important to care for during such a crisis. Hence, it is important to proactively develop appropriate strategies to alleviate stress by screening, identifying and managing perinatal mental health disorders during the pandemic, without delay. Internet-based screening tools, virtual online consultations/counseling and web-based psychological support and therapeutic interventions may have an important role in this regard. None.

Background Pregnant migrants are particularly vulnerable to mental illness because they are exposed to stressors including conflict, poverty, and discrimination. We aimed to assess the global prevalence of perinatal mental health disorders or substance use among migrant women. Methods We searched MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in the perinatal period or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal mental health disorders amongst migrant women globally. A random-effects meta-analysis was used to calculate pooled prevalence estimates. PROSPERO: CRD42021226291. Results 18,650 studies were retrieved, of which 135 studies (comprising data from 621,995 participants) met the inclusion criteria. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all migrant women, 32·5% (1·5-81·6; 98·7%; τ2 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; τ2 0·01) among economic migrants (p &amp;lt; 0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Conclusions One in four migrant women who are pregnant or postpartum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher amongst forced migrant women compared to economic migrants. These findings highlight the need for community-based perinatal mental health screening and access to interventions that are culturally sensitive. Key messages • Women who are forced migrants have a higher prevalence of perinatal depressive disorders compared with women who are economic migrants; forced migrants also experience a high burden of PTSD. • The findings highlight the need for culturally sensitive mental health screening and care for migrant women who are pregnant or postpartum, particularly for forced migrants.

THE BURGEONING BURDEN OF PERINATAL MENTAL HEALTH IN LOWER MIDDLE-INCOME COUNTRIES

Cultural perceptions and social determinants of health in perinatal mental health: An obstetric-psychiatric perspective.