Perinatal Mental Disorders Research Articles

Validated screening tools to identify common mental disorders in perinatal and postpartum women in India: a systematic review and meta-analysis

BackgroundPerinatal common mental disorders are associated with significant adverse outcomes for women and their families, particularly in low- and middle-income settings. Early detection through screening with locally-validated tools can improve outcomes.MethodsWe searched MEDLINE, Embase, PsycINFO, Global Health, Cochrane Library, Web of Science and Google Scholar for articles on the validation of screening tools for common mental disorders in perinatal women in India, with no language or date restrictions. Quality was assessed using the QUADAS-2 tool. We used bivariate and hierarchical summary receiver operating characteristic models to calculate pooled summary estimates of sensitivity and specificity. Heterogeneity was assessed by visualising the distance of individual studies from the summary curve.ResultsSeven studies involving 1003 women were analysed. All studies assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS) in identifying perinatal depression. No validation studies of any other screening tools were identified. Using a common threshold of ≥13 the EPDS had a pooled sensitivity and specificity of 88·9% (95%CI 77·4–94·9) and 93·4 (95%CI 81·5–97·8), respectively. Using optimal thresholds (range ≥ 9 to ≥13) the EPDS had a pooled sensitivity and specificity of 94·4% (95%CI 81·7–98·4) and 90·8 (95%CI 83·7–95·0), respectively.ConclusionThe EPDS is psychometrically valid in diverse Indian settings and its use in routine maternity care could improve detection of perinatal depression. Further research is required to validate screening tools for other perinatal common mental disorders in India.

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

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

Development and efficacy of a psychoeducational family intervention for perinatal depression

Abstract BodyThe perinatal period represents an at-risk period for mental health consequences, which has been overlooked for long time. Perinatal mental health problems constitute a relevant threat for long-term mental health, not only for the direct impact on the affected women, but also for the considerable foetal/infant morbidity and mortality. Perinatal mental disorders are associated with negative outcomes in the newborn, including an increased risk of premature delivery and infant mortality, as well as a higher prevalence of mental disorders in the offspring (e.g., attention deficit or anxiety disorders). Depressive disorders represent the most common disorder during the perinatal period. For the adequate, appropriate and complete management of women with perinatal depression, there is the need for integrated interventions, following a comprehensive global assessment of women’s mental health. In particular, the management of depression during perinatal period requires special attention, even considering the problems and limitations in prescribing pharmacological drugs. In this context, psychoeducational interventions are effective in reducing affective symptoms and the levels of stress, with low costs for the mental health department.DisclosureNo significant relationships.

Family healing: Contextual interventions in perinatal clinical practice

Abstract BodyIn perinatal clinical practice (PCP), the focus of care has shifted from the mother and then the baby-mother dyad to the emphasis on the role of fathers. Individual and therapeutic interventions are multimodal, and in almost all cases interdisciplinary cooperation is assumed. The preferred therapeutic methods for perinatal mental disorders are psychological and psychotherapeutic interventions. Through the life-course model, the central, therapeutic-conceptual role of the family can be understood, which - in clinical practice - reflects the need for “think-family” in psychiatric care. Hence there is a growing need for evidence-based family-interventions. Parental mental health disorders may have an impact on family functioning and partner relationship, as well as parent-child interactions, the quality of attachment and relationship with the child. Even though we have an increasing number of evidence regarding the aims and effectiveness of family interventions, additional evidence is needed to determine what interventions and modalities are effective in the perinatal period. And we also need information when these interventions are contraindicated and regarding their risk. It is conceivable that there is not much difference between the efficacy of family intervention methods used in other indications and the perinatal application of the same methods. We have gathered evidence primarily on perinatal depression, which opens the path of family interventions in other disorders. When thinking in the family as a general framework, it should be filled with evidence-based quantitative and qualitative anchors. The conceptual framework can be based on systems- and network theory. The presentation is illustrated with clinical vignettes.DisclosureNo significant relationships.

Suicide and self-harm in women with mental disorders during pregnancy and the year after birth

IntroductionThere is little prospective data on the risk factors for later suicide in women who experience perinatal mental disorders, particularly beyond one-year postnatal.ObjectivesAmong a cohort of women who were in contact with a mental healthcare provider during the perinatal period, to: (1) Describe sociodemographic and clinical characteristics of the women who died by suicide (2) Understand when, in relation to childbirth, most suicides tended to occur.MethodsData-linkage of de-identified service-user electronic healthcare records, national hospital episode statistics and mortality data generated a cohort of women in contact with a mental healthcare service provider in London, UK, perinatally. Using Natural Language Processing and structured field extraction, we identified clinical, socio-demographic characteristics, self-harm exposure, and suicide.ResultsAmong 5204 women, clinical and demographic characteristics of women who did and did not die by suicide were similar apart from indicators of illness severity including perinatal sedative medication prescription, clinician-rated functional impairment and smoking, which were more common in women who died by suicide. Suicide deaths occurred most frequently in the second year post-delivery. The most common method of suicide ocurring wihtin two years was by violent means, whereas after two years postnatal, the most common method was non-violent.ConclusionsOur findings support the extension of perinatal mental healthcare service provision to two years post-delivery.DisclosureNo significant relationships.

Microbial Enzymes Used in Bioremediation

Emerging pollutants in nature are linked to various acute and chronic detriments in biotic components and subsequently deteriorate the ecosystem with serious hazards. Conventional methods for removing pollutants are not efficient; instead, they end up with the formation of secondary pollutants. Significant destructive impacts of pollutants are perinatal disorders, mortality, respiratory disorders, allergy, cancer, cardiovascular and mental disorders, and other harmful effects. The pollutant substrate can recognize different microbial enzymes at optimum conditions (temperature/pH/contact time/concentration) to efficiently transform them into other rather unharmful products. The most representative enzymes involved in bioremediation include cytochrome P450s, laccases, hydrolases, dehalogenases, dehydrogenases, proteases, and lipases, which have shown promising potential degradation of polymers, aromatic hydrocarbons, halogenated compounds, dyes, detergents, agrochemical compounds, etc. Such bioremediation is favored by various mechanisms such as oxidation, reduction, elimination, and ring-opening. The significant degradation of pollutants can be upgraded utilizing genetically engineered microorganisms that produce many recombinant enzymes through eco-friendly new technology. So far, few microbial enzymes have been exploited, and vast microbial diversity is still unexplored. This review would also be useful for further research to enhance the efficiency of degradation of xenobiotic pollutants, including agrochemical, microplastic, polyhalogenated compounds, and other hydrocarbons.

Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study.

Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.

Maternal mental health services in Sri Lanka: challenges and solutions.

Sri Lanka boasts of making significant strides in the indicators of maternal healthcare during the past few decades. However, these indicators mostly look only at the physical well-being of women. Lack of awareness regarding maternal mental health problems among grass-root level healthcare workers, poor integration of services, and the culture and stigma regarding perinatal mental disorders are barriers to improving services in maternal mental healthcare in Sri Lanka.

Suicide and Self-Harm in Women with Mental Disorders During Pregnancy and the Year after Birth

Background: Despite the strong links between mental disorder, self-harm and suicide, there is little prospective data on risk factors for later suicide in women who experience perinatal mental disorders. We aimed to examine later suicide in a cohort of women in contact with a mental healthcare provider perinatally and whether self-harm increased suicide risk. Methods: Via data-linkage, de-identified service-user electronic healthcare records, national hospital episode statistics and mortality data generated a clinical cohort of women who gave birth in hospital and were in contact with a mental healthcare provider in London, UK, perinatally. Using Natural Language Processing and structured field extraction, we identified clinical, socio-demographic characteristics, self-harm, and suicide. Outcomes: Among 5204 women, crude rate of suicide 9·69/100 000 person-years (95% CI 3·64 - 25·82) within one year of delivery; 27·56 (15·26 - 49·77) within two, and 55·12 (36·29 - 83·71) during total follow up time (39,912·9 person-years). Characteristics of women who did and did not die by suicide were similar apart from illness severity indicators, which were more common in women who died by suicide. In a Cox regression model, lifetime self-harm was not associated with later suicide. Suicides occurred most frequently in the second year after delivery, most commonly by violent means. Suicides beyond two years were most commonly by poisoning. Interpretation: This study provides support for the extension of perinatal mental healthcare to two years post-delivery, particularly for women with severe mental disorders. Funding : The National Institute for Health Research, King's College London Biomedical Research Council, Health Foundation, Academy of Medical Sciences. Declaration of Interests: None. Ethics Approval Statement: CRIS has pre-existing ethical approval via the Oxfordshire Research Ethics Committee C (ref 18/SC/0372). The use of HES data is included in the CRIS REC approval and the BRC also have approval through the Health Research Authority’s support under Section 251 of the NHS Act 2006 (Ref: ECC 3- 04(f)/2011). Linkage between CRIS and ONS Mortality data is approved via the Health Research Authority’s support under Section 251 of the NHS Act 2006. Individual CRIS projects require ethical approval from the CRIS Oversight Committee (approval 16-069), which is chaired by a service-user and member of the SLAM BRC Stakeholder Participation theme.

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

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

Perinatal mental health: a review of progress and challenges.

Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

Perinatal mental health and the COVID-19 pandemic.

Perinatal mental health and the COVID-19 pandemic.

Advances in virtual care for perinatal mental disorders.

Advances in virtual care for perinatal mental disorders.

Paternal perinatal mental disorders are inextricably linked to maternal and child morbidity.

Paternal perinatal mental disorders are inextricably linked to maternal and child morbidity.

Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis

Abstract Background Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome. Results Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher. Conclusions While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment. Key messages One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.

Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool.

Physical activity can reduce pregnancy-related complications and contributes substantially to improving maternal mental health. A reduction in activity encompassing exercise and daily household tasks throughout the course of pregnancy increases the risk of depression and anxiety. The following research examines the longitudinal interaction between exercise, general physical activity, and mental health outcomes in pregnant women. This prospective longitudinal study was conducted at the maternity departments of two major university hospitals in Germany. Self-reported data of 597 women were digitally assessed every 4weeks from the second trimester until birth as well as 3 and 6months postnatally. Depressive and anxiety symptoms were assessed using the EPDS, PRAQ, and STAI and physical activity levels were measured using the PPAQ questionnaire. Cross-sectional and longitudinal analyses using Pearson's correlation coefficient and multiple regression models were conducted. We found a significant reduction in general physical activity in the period from the 20th to 32nd gestational week. Women who reported a greater decline during pregnancy showed significantly higher depression and anxiety scores. In stratified analyses, only baseline mental health scores proved to be variables with stronger impact on postnatal depression and anxiety outcomes. General physical activity and maternal mental health significantly influence each other during and after pregnancy. Both physical activity and the prevention of perinatal mental disorders should be systematically encouraged during perinatal care to prevent adverse maternal and fetal birth outcomes.

Perinatal mental health around the world: priorities for research and service development in Africa.

Africa is a diverse and changing continent with a rapidly growing population, and the mental health of mothers is a key health priority. Recent studies have shown that: perinatal common mental disorders (depression and anxiety) are at least as prevalent in Africa as in high-income and other low- and middle-income regions; key risk factors include intimate partner violence, food insecurity and physical illness; and poor maternal mental health is associated with impairment of infant health and development. Psychological interventions can be integrated into routine maternal and child healthcare in the African context, although the optimal model and intensity of intervention remain unclear and are likely to vary across settings. Future priorities include: extension of research to include neglected psychiatric conditions; large-scale mixed-method studies of the causes and consequences of perinatal common mental disorders; scaling up of locally appropriate evidence-based interventions, including prevention; and advocacy for the right of all women in Africa to safe holistic maternity care.

Screening for Detection of the Risk of Perinatal Mental Disorders among Women in Poland

The aim of the study was to assess the severity of depressive symptoms, to analyze risk factors for perinatal mental disorders and to assess dispositional optimism. A total of 106 women from Poland were included in the study at 37-week pregnant and 6 weeks after giving birth. It was demonstrated that the main predictors of perinatal mental disorders were the variables: mental health disorders before pregnancy, subjectively reported decreased mood in pregnancy, the lack of social (instrumental) support and the tendency to pessimism. The results of the study suggest how important it is to introduce clinical practice in Poland to screen for early detection of the risk of depression during pregnancy and postpartum depression.

Psychosocial disadvantage and residential remoteness is associated with Aboriginal women's mental health prior to childbirth.

IntroductionOptimal mental health in the pre-conception, pregnancy and postpartum periods is important for both maternal and infant wellbeing. Few studies, however, have focused on Indigenous women and the specific risk and protective factors that may prompt vulnerability to perinatal mental disorders in this culturally diverse population.ObjectivesTo assess mental health contacts in the period before childbirth among Australian Aboriginal and Torres Strait Islander women, the association with socioeconomic factors and whether it differs by geographic remoteness.MethodsThis is a retrospective cohort study of 19,165 Aboriginal mothers and includes all Aboriginal mothers and their children born in Western Australia from January 1990 to March 2015. It draws on population-level, linked administrative data from hospitals and mental health services, with a primary focus on the mental health contacts of Aboriginal women in the 5 years leading up to childbirth.ResultsThe prevalence of maternal mental health contacts in the five years prior to birth was 27.6% (93.6% having a single mental health disorder), with a greater likelihood of contact in metropolitan areas compared with regional and remote settings. There was a positive relationship between socioeconomic advantage and the likelihood of a mental health contact for women in Metropolitan (β = 0.044, p=0.003) and Inner regional areas (β = 0.033, p=0.018), and a negative association in Outer regional (β = -0.038, p=0.022), Remote (β = -0.019, p=0.241) and Very remote regions (β = -0.053, p<0.001).ConclusionsThe findings from this study provide new insights on the dynamic relationship between SES, geographic location and mental health issues among Aboriginal women in the 5 years leading up to childbirth. The results underscore the need to apply location-specific approaches to addressing the material and psychosocial pathways that lead to mental health problems and the provision of culturally safe, appropriate and accessible services for Aboriginal women

When Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression.

The transition to parenthood is considered to be a major life transition that can increase the vulnerability to parental depressive disorders, including paternal perinatal depression (PPND). Although it is known that many fathers experience anxiety and depression during the perinatal period, PPND is a recent diagnostic entity and there are not enough published studies on it. Accordingly, its prevalence and epidemiology are still not well defined, although the majority of studies agree that PPND is less frequent than maternal perinatal depression and postpartum depression. Nevertheless, PPND is different from maternal perinatal mental health disorders, usually, fathers have less severe symptoms, and mood alterations are often in comorbidity with other affective disorders. Despite the absence of DSM-5 diagnostic criteria and the fluctuation of prevalence rates, clinical symptoms have been defined. The main symptoms are mood alterations and anxiety, followed by behavioral disturbances and concerns about the progress of pregnancy and the child’s health. Moreover, PPND negatively impacts on family functioning, on couples’ relationships, and on family members’ well-being. The aim of this paper is to present an overview of the current understandings on PPND and the potential screening, prevention, and treatment options.