Introduction to Perinatal

Mental Health
Cesa Septiana Pratiwi| Prodi S2 Kebidanan| Universitas Aisyiyah
Yogyakarta

17/11/2017
Prologue

Women are the real architects of society

Harriet Beacher Stowe.
https://www.youtube.com/watch?v=6fn0DKul_D4&t=1s (Kick Andy part 1)
https://www.youtube.com/watch?v=RN1DBY8hR18&t=1s (Kick Andy part 2)
https://www.youtube.com/watch?v=y5Axt5SFw8E
https://www.youtube.com/watch?v=q7XPtM_I8Xo&t=776s
https://www.youtube.com/watch?v=DR92zpaG9dU&t=16s
Introduction

Perinatal mental health have been studied in more than 90% of

high income countries, whereas only 10% of information available
low and middle income countries

Impact of maternal mental health problems on infants, either

psychosocial or emotional development

The perinatal period is a time of increased physical and emotional

demands on the woman, and the disability associated with
depression is likely to interfere with many essential functions
related both to the mother and the infant.

Contribution to the Global Burden Disease (GBD)

Interesting facts
WHO : depression disorder will be the second global
burden in 2020
In general women are three times more vulnerable to
experience a depressive disorder than are men
(Weissman et al. 1993)
The rates of both, first onset and severe depression were
three times higher in the postnatal period than during
other periods of women's lives.
Prevalence of psychiatric morbidity in the postnatal
period varied between 10-15% in developed countries
The number in developing countries even higher than
that in developed countries
Prevalence
Understanding mental health: theoretical approaches

Biomedical model: the disease is an organics condition and dispels non-organic factors associated with
emotional behaviour and symptoms (Haslam, 1798, Kraeppelin in Diedfendorf, 1912)
Social model/ social construction/ sociocultural-: Mental illness has to some extent an uneasy relationship
with sociology. Environment, social, and cultural maladjustment including low socioeconomic, poor social
support and stressful live events play as important roles in influencing the development of mental disorder
(Anthony, 2001) --- Cognitive Behavioural Paradigm (Wundt, 1879; Pavlov, 1928; Skinner, 1953)
Psychosocial model: draws on psychodynamic theory derived from the work of Sigmund Freud. It is believed
that abnormal behaviour is caused by the presence of unconscious mental conflict rooted during early
childhood period followed by inability of the ego to cope with stress and resulting in defence mechanisms
(Freud, 1955)
Biopsychosocial model: Answer for new medical model in the concept of health and illness. Integrated
biomedical, sociocultural and psychosocial in a scientific way still considering their interconnections and
interdependence (Engel, 1977)
 Risk factors
During pregnancy:
Adolescent pregnancy
Being unmarried or separated
Unwanted pregnancy
Marital relationship: unsupportive;
polygamous
Previous stillbirth or repeated miscarriage
Nulliparity
Poverty and lack of financial resources
Lack of practical support
Pregnancy as a result of rape
Spouse/domestic violence
Difficult relationship with in-laws
After childbirth:
Difficulties with husbands behaviour
(physical violence; verbal abuse; alcohol use;
being illiterate and unemployed; providing
little assistance; rejecting the pregnancy)
Inability to confide in partner
Poverty (low income; lack of personal
income generating activity; inadequate
housing)
Overcrowding and lack of privacy
Unintended pregnancy
Adolescent pregnancy
Unmarried
Antenatal depression or severe anxiety
Illnesses during pregnancy,
antenatal hospital admission,
operative birth
Large number of children
Infant unsettled, sick, not thriving
Problematic relationship with in-law
family (mother-in-law and sister-in-
law)
Birth of a girl child in cultures over-
valuing boy child
Lack of sustained, dedicated,
practical care after birth for the
culturally prescribed period
Past psychiatric history
Other stressful life events
Consequences
Impact of maternal mental health problems on their infants
Infants of depressed mothers show dysregulations
affecting their behaviour and physiology, thought to
be derived from a prenatal exposure to a biochemical
imbalance in their mothers
Newborns of depressed mothers also have
neurotransmitter imbalances (e.g., higher cortisol and
lower dopamine and serotonin levels)
This poorer performance is also at risk of being
reinforced by the disturbed postnatal interactions
offered by their depressed mothers. Reciprocally,
infants born to depressed mothers may discourage
the mother's effort to interact with their infant and
thereby entrain a vicious circle of disturbed and
poorer interactions
Impact of maternal mental health problems on their infants

Neonates of mothers with high anxiety levels during pregnancy have decreased motor maturity and vagal
tone when compared to those of non-anxious mothers.
cry more
change more frequently from one behavioural state to another; they are perceived by their mothers as having a
more difficult temperament
they also have more gastro-intestinal problems and delayed growth

inattention, and hyperactivity in children aged 4 years

lower regulation of emotional states, poorer motor performance and significantly impaired orientation.
lower mental developmental scores at the age of 2 years
Risk factor independent from obstetric and other factors, to several unwanted outcomes (LBW and poor
nutritional status)
Cont.
increased admission to neonatal care unit
higher rates of diarrhoeal diseases;
higher rates of infectious illness and hospital
admissions
diminished completion of recommended
immunization schedules, and
worse physical, cognitive, social, behavioural
and emotional development in children
Conclusion

Mental health problems of pregnant women and mothers of newborns in LMICs

is a serious but under-recognized public health problem, making a substantial
contribution to maternal and infant morbidity and mortality.
One in three to one in five pregnant women and mothers of newborns
experience significant mental health problems, the most common of which are
depression and anxiety states (e.g. 12.5 - 42% of pregnant women and, 12 - 50%
of mothers of newborns in LMICs screen positive for symptoms of depression).
Suicide is one of the leading causes of pregnancy-related deaths.
Mothers whose mental health is poor are less able to care for themselves and
their infants, whose survival, health and development could be then
compromised.
Poor maternal mental health may affect the health and development of children.
For instance, maternal depression in the prenatal and postnatal periods predicts
Epilogue

Maternal mental health is inextricably linked with both physical and psychological development of children.
Addressing the mental health needs of the mother is likely to benefit these important outcomes. However,
maternal mental health has been ignored in both child nutrition and development programmes and it may be
the missing link in maternal and child health programmes.
Resources

https://www.nice.org.uk/guidance/cg192/evidence/full-guideline-pdf-193396861
http://apps.who.int/iris/bitstream/10665/152936/1/WHO_MSD_MER_15.1_eng.pdf?ua=1&ua
=1
http://www.who.int/bulletin/volumes/90/2/11-091850/en/
http://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf
?ua=1