Perceptions and attitudes around perinatal mental health in Bangladesh, India and Pakistan: a systematic review of qualitative data

A global perspective: Access to mental health care for perinatal populations

Perinatal mental health care differs around the world. We provide a global perspective on the current status of service provision, barriers and facilitators to access, and strategies to improve access in high-income and low- and middle-income countries across five continents (Asia, Africa, Europe, North America and South America). Many of the countries considered do not have universal healthcare coverage. This poses a challenge to perinatal mental health care access. However, there are other social and structural barriers to access, including stigma and other sources of marginalization and discrimination. Yet there are opportunities discussed herein to learn more about what perinatal mental health services work for what populations* and in what circumstances, by adopting a global lens to examine innovative solutions utilized across geographical settings.

Mental disorders during pregnancy and postpartum in Bangladesh: A narrative review

Background and Aims

Bangladesh has made significant progress in declining maternal mortality in recent decades. However, the available evidence on the various maternal mental disorders in the country has not been comprehensively and critically reviewed to date. This narrative review aimed to assess the mental disorders and associated factors during pregnancy and postpartum in Bangladesh.

Methods

A thorough search was performed in PubMed, Scopus, Google, Google Scholar, and BanglaJOL with search terms at the end of January 2024 to identify the original articles published on psychiatric morbidities during pregnancy and postpartum.

Results

This review included 28 empirical studies published between 2007 and 2023 with a sample size ranging from 100 to 39,434. Two studies were published before 2010, 16 studies were published between 2011 and 2020, and 10 studies were published between 2021 and 2023. No countrywide study was noted, the Bangla Edinburgh Postnatal Depression Scale (EPDS-B) was used in 57% of studies, suicidal behavior was assessed in three studies, postpartum depression (PPD) was featured in 16 studies, and three qualitative studies were noted. The prevalence of PPD ranged from 9% to 51.7%. About 46% of mothers had positive scores for common mental disorders. The prevalence of mental disorders was 14.2%; among them mood disorders were present at 6.1% and psychoses were noted at 4.5%.

Conclusions

There are wide variations in the prevalence of maternal mental disorders in Bangladesh from study to study; a lower prevalence was noted when diagnostic tools were used even though no nationwide study with confirmatory diagnostic tools was noted. Studies with nationwide distribution and diagnostic tools are warranted to understand the problem precisely.

Seeking help for perinatal depression and anxiety: a systematic review of systematic reviews from an interdependent perspective

BACKGROUND

Seeking help for perinatal mood and anxiety disorders is crucial for women's mental health and babies' development, yet many women do not seek help for their condition and remain undiagnosed and untreated. This systematic review of systematic reviews aimed at summarizing and synthesizing findings from all systematic reviews on seeking help for PMAD in the context of interdependence theory, highlighting the interdependent relationship between women and healthcare providers and how it may impact women's seeking-help process.

METHODS

Four electronic databases were searched, and 18 studies published up to 2023 met inclusion criteria for review.

RESULTS

The capability, opportunity and motivation model of behavior was used as a framework for organizing and presenting the results. Results demonstrate that seeking help for PMAD is a function of the interdependent relationship between perinatal women's and healthcare providers' psychological and physical capabilities, social and physical opportunities, and their reflective and automatic motivation.

CONCLUSIONS

Unmet needs in perinatal mental healthcare is an important public health problem. This systematic review of systematic reviews highlights key factors for policymakers, researchers, and practitioners to consider to optimize healthcare systems and interventions in a way that enhances perinatal women's treatment whenever necessary.

Promoting mental wellbeing in pregnant women living in Pakistan with the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention: a randomized controlled trial

BACKGROUND

The negative impact of adverse perinatal mental health extends beyond the mother and child; therefore, it is essential to make an early intervention for the management of mental illness during pregnancy. Resilience-building interventions are demonstrated to reduce depression and anxiety among expectant mothers, yet research in this field is limited. This study aims to examine the effect of the 'Safe Motherhood-Accessible Resilience Training (SM-ART)' on resilience, marital adjustment, depression, and pregnancy-related anxiety in a sample of pregnant women in Karachi, Pakistan.

METHOD

In this single-blinded block randomized controlled study, 200 pregnant women were recruited and randomly assigned to either an intervention or a control group using computer-generated randomization and opaque sealed envelopes. The intervention group received the SM-ART intervention consisting of six, weekly sessions ranging from 60 to 90 min. Outcomes (Resilience, depression, pregnancy-related anxiety and marital harmony) were assessed through validated instruments at baseline and after six weeks of both intervention and control groups.

RESULTS

The results revealed a significant increase in mean resilience scores (Difference:6.91, Effect size: 0.48, p-value < 0.05) and a decrease in depressive symptoms (Difference: -2.12, Effect size: 0.21, p-value < 0.05) in the intervention group compared to the control group. However, no significant change was observed in anxiety and marital adjustment scores.

CONCLUSION

The SM-ART intervention has the potential to boost resilience scores and decrease depressive symptoms in pregnant women and offers a promising intervention to improve maternal psychological health.

TRIAL REGISTRATION

NCT04694261, Date of first trial registration: 05/01/2021.

S. M, H. S. V, Philip M, G. S, Rajaram D, Acharya S, Vaiphei K, A. R. S. Study on awareness and management based health action using video intervention (SAMBHAV) for postpartum depression among mothers attending immunisation clinic in a tertiary medical college hospital: Study protocol

INTRODUCTION

Pregnancy exerts a detrimental effect on women's mental health. Maternal mental health is considered as one of the public health concerns as it impacts the health of both mother and the child. One in five people in developing countries experience serious mental health issues during pregnancy and after giving birth. In India, postpartum depression (PPD) affects 22% of women, according to a research by WHO. The available data on mental health literacy among women, showed that only 50.7% of the postpartum mothers who were attending paediatric tertiary care centres had adequate knowledge about PPD. It is crucial to diagnose early and adequately manage postpartum depression to avoid long-term consequences. It is also essential to seek help and utilise the available resources and services to avoid worsening of the condition and to aid in the recovery. This demonstrates the need to promote awareness, improve help seeking, reduce stigma and treatment gap associated with PPD through educational video intervention specific to cultural context and beliefs.

MATERIALS AND METHODS

This is a quasi-experimental study without a control group that attempts to improve the awareness among the mothers about postpartum depression to understand better about the condition and also its management through video intervention. The video intervention will be developed in regional language specific to the cultural context of the setting. The video script will be finalised from the findings of the available literature and also through focus group discussion among mothers and health care professionals which will be analysed qualitatively using thematic identification. The study will use a standardized Postpartum Depression Literacy Scale (PoDLIS) which will be quantitatively analysed using paired t test before and after the intervention. Repeated measures of ANOVA will also be used to analyse the changes in literacy scale scores with respect to socio demographic variables. The mothers will also be screened for PPD using Patient Health Questionnaire 9 (PHQ 9) and feedback will be collected and analysed to find the overall usefulness of video.

DISCUSSION

If it becomes apparent that this video intervention is successful in raising awareness of PPD among postpartum mothers and reducing stigma, it can be used to aid early identification of mothers with PPD which can result in early management and improved health outcome for both mothers and children. The major goals of the video intervention are to raise awareness, lessen stigma, and prevent PPD through strong family support, adopting healthy lifestyles, having access to information, practising self-care, and enhancing help-seeking.

TRIAL REGISTRATION

The trial is registered under the Clinical Trial Registry- India (CTRI) (CTRI/2023/03/050836). The current study adheres to the SPIRIT Guidelines [See S1 Checklist: SPIRIT Guidelines].

Knowledge, Attitude and Perceptions Around Perinatal Mental Health Among Doctors in an Obstetrics and Gynaecology Academic Department in Singapore

Background Frontline healthcare professionals who provide regular care to women in the antenatal and postnatal period play a critical role in the early detection and management of maternal perinatal mental health (PMH). This study aimed to assess the knowledge, attitudes, and perceptions of doctors around perinatal mental health in an obstetrics and gynaecology (O&G) department in Singapore. Methods Using an online survey, data was collected from 55 doctors who participated in the Doctor's Knowledge, Attitudes and Perceptions of Perinatal Mental Health (I-DOC) study. The survey questions assessed the knowledge, attitudes, perceptions and practices in relation to PMH among doctors in the O&G specialty. Descriptive data was presented as means and standard deviations (SDs), or frequency and percentages. Results Out of the 55 doctors, more than half (60.0%) were not aware of the adverse impacts of poor PMH; 83.7% of doctors were not confident in providing PMH advice and 65.5% did not routinely screen patients for PMH disorders. There was a lower percentage of doctors (10.9% vs. 34.5%, p<0.001) who discussed PMH issues in the antenatal period compared to the postnatal period and this was statistically significant. Majority of doctors (98.2%) agreed that having standardised PMH guidelines will be useful. All doctors agreed on the benefits of having PMH guidelines, education and routine screening for patients. Conclusion There is inadequate PMH literacy among O&G doctors and lack of emphasis on antenatal PMH disorder. The findings highlighted the need for increased education and development of perinatal mental health guidelines.

Perinatal mental disorders associated with adverse childhood experiences in Asian countries; call to practice recommendations

Perinatal depression (PND) is a major health risk to the mother and her unborn child and is linked to negative events. For example, PND has been related to a rise in suicides, a decline in a mother's quality of life, and a baby's stunted neurobiological development. In addition, recent research has shown that a mother's Adverse Childhood Experiences (ACEs) might predispose her to perinatal depression, with the prevalence of PND being comparably greater in Asian and lower-income nations. Our paper clarified the relationship between PND and ACEs and the steps Asian countries could take to combat the rising PND rates.

Does antenatal depression predict post-partum depression and obstetric complications? Results from a longitudinal, long-term, real-world study

BACKGROUND

Main aims of the present paper are to: (1) assess the prevalence of antenatal depression (AD) and identify its predictors; (2) analyse the impact of AD on obstetric outcomes and on the incidence of post-partum depression.

METHODS

All pregnant women referring to the Gynecology and Obstetrics inpatients unit of the University of Campania "Luigi Vanvitelli" were invited to participate. Upon acceptance, women completed the Italian version of the Edinburgh Postnatal Depression Scale and an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women were assessed at each trimester of pregnancy, immediately after the childbirth and after one, three, 6 and 11 months.

RESULTS

268 pregnant women were recruited, with a mean of 32.2 (±5.81) years. Ninety-seven women (36.2%) reported the presence of depressive symptoms during pregnancy. Predictors of AD were personal history of depression, a family history for depressive disorders and problematic relationships with the partner. The presence of AD was associated to a reduced gestational age at the time of delivery, a lower APGAR score at 1 and 5 min, labor induction and admission of the new-born into neonatal intensive care unit. Mothers with antenatal depression are less likely to natural breastfeed. Lastly, antenatal depression was a risk factor for higher EPDS scores at follow-ups.

CONCLUSIONS

Our results support the idea that women should be screened during pregnancy and post-partum for the presence of depressive and anxiety symptoms. Health professionals should be adequately trained to detect psychiatric symptoms during pregnancy.