Perinatal Mental Illness in the Middle East and North Africa Region—A Systematic Overview

Amit Abraham,Sathyanarayanan Doraiswamy,Karima Chaabna,Sonia Chaabane,Sohaila Cheema,Anupama Jithesh

doi:10.3390/ijerph17155487

Abstract

Aims: Perinatal mental illness (PMI) is associated with a high risk of maternal and infant morbidity. Recently, several systematic reviews and primary studies have explored the prevalence and risk factors of PMI in the Middle East and North Africa (MENA) region. To our knowledge, there has been no critical analysis of the existing systematic reviews (SRs) on this topic in the MENA region. Our systematic overview primarily aimed to synthesize evidence from the published SRs on PMI in the MENA countries focusing on a) the prevalence of PMI and b) the risk factors associated with PMI. Methods: We conducted a systematic overview of the epidemiology of PMI in the Middle East and North Africa region by searching the PubMed, Embase, and PsycInfo databases for relevant publications between January 2008 and July 2019. In addition to searching the reference lists of the identified SRs for other relevant SRs and additional primary studies of relevance (those which primarily discussed the prevalence of PMI and/or risk and protective factors), between August and October 2019, we also searched Google Scholar for relevant studies. Results: After applying our inclusion and exclusion criteria, 15 systematic reviews (SRs) and 79 primary studies were included in our overview. Studies utilizing validated diagnostic tools report a PMI prevalence range from 5.6% in Morocco to 28% in Pakistan. On the other hand, studies utilizing screening tools to detect PMI report a prevalence range of 9.2% in Sudan to 85.6% in the United Arab Emirates. Wide variations were observed in studies reporting PMI risk factors. We regrouped the risk factors applying an evidence-based categorization scheme. Our study indicates that risk factors in the relational, psychological, and sociodemographic categories are the most studied in the region. Conversely, lifestyle-related risk factors were less studied. Conclusions: Our systematic overview identifies perinatal mental illness as an important public health issue in the region. Standardizing approaches for estimating, preventing, screening, and treating perinatal mental illness would be a step in the right direction for the region.

Highlights

Mental illness in women during the perinatal period can have a significant impact on maternal and infant morbidity [1,2] Perinatal mental illness (PMI)include depression, anxiety, and postpartum psychoses, the latter of which usually manifests as bipolar disorder [1]
We aimed to summarize measurement variations in PMI, to identify research gaps, and to provide recommendations to improve the mental health of perinatal women in the region
This overview is part of a series of research and publications aimed at synthesizing available literature on population health issues in the Middle East and North Africa (MENA) region, assessing them for their quality with an aim of contributing to improving the quality of evidence generated in the region [14,15]

Summary

Introduction

Mental illness in women during the perinatal period (start of pregnancy until one year postpartum) can have a significant impact on maternal and infant morbidity [1,2] Perinatal mental illness (PMI). Include depression, anxiety, and postpartum psychoses, the latter of which usually manifests as bipolar disorder [1]. Studies report suicide as one of the major causes for maternal mortality in several countries [3,4]. The mental health of women during the perinatal period has a profound impact. Res. Public Health 2020, 17, 5487; doi:10.3390/ijerph17155487 www.mdpi.com/journal/ijerph

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