Globally one in three women of developing countries and one in ten women of developed countries are suffering from some form of mental health problem either during pregnancy or after childbirth . Depression and anxiety are the major mental health disorders seen among the mothers and numbers of suicides among severe cases are increasing day by day. Mental health problem among the mother adversely affects the child’s growth and development as well. Maternal mental health disorders are preventable and also easily treatable if identified early. And, most of these problems can be easily managed even by non-specialist healthcare providers who are properly trained. In order to achieve the Millennium Development Goal (MDG) 5 of improving maternal health, efforts should include measures for prevention and management of maternal mental health disorders .
Any women can develop mental health problems during pregnancy and first year after child birth. Socio-cultural determinants are an important risk factor in the development of mental health disorders in a mother, especially in developing countries. Factors which have been incriminated are: poverty, extreme stress, domestic or gender based violence, unintended pregnancy, teenage pregnancy, emergency and conflict situations, natural disasters, and low social support. If the mother has some pre-existing psychological illness, it may lead to severe depression, substance abuse and suicidal attempts, especially in cases associated with an unwanted pregnancy .
Depression is being diagnosed as the most common mental health disorder in mothers and it usually presents with symptoms such as persistent sadness, hopelessness, changes in appetite, difficulty in sleeping, extreme fatigue, recurrent thoughts of death or suicide, etc. another common problem is anxiety disorders which can have various forms such as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and post-traumatic stress disorder. A small percentage of women suffer from a severe form of mental health disorder known as postpartum psychosis and those with a family or personal history of a bipolar disorder are at risk of developing this disorder. The onset of postpartum psychosis will occur within first two weeks of childbirth and the symptoms commonly reported are delusions, hallucinations, irritability, hyperactivity, rapid mood swings, etc,. .
Most of the mental health disorders are undiagnosed, as many of the features such as insomnia or easy fatigability are part of motherhood itself and mostly go unnoticed. Many of the mothers with mental health problem will be having poor physical health and have increased risk of pregnancy related complications like pre-term labour. They will also be reluctant to seek for antenatal or postnatal care and also find it difficult to follow any healthcare activity. Suicides are increasingly common both in developed and developing countries. Mental health disorders increase the rate of maternal mortality by means of rise in number of suicides as well as by reducing the physical health of the individual. Mental health of the mother significantly affects the physical, cognitive, behavioural and social development of a child. Maternal depression in low resource settings has been linked to low birth weight, high rates of diarrhoea, increased rates of growth retardation and failure of proper immunization in the child. It has been proved that management of mental health disorders in a mother not only leads to better growth and development in a child, but also it decreases the chances of malnutrition in the child [3,5].
Mental health component should be made a part of maternal health policies and programmes, so as to facilitate the goal of achieving MDG 5 (improving maternal health) . Approaches for achieving mental health are usually simple and should become a part of basic health service system. Many community based interventions have proved their effectiveness in managing maternal mental health problems. Health workers who are already involved in reproductive healthcare can be easily trained to identify the symptoms of a mental health disorder and provide needed psychological support. Only a small segment of the mothers may require specialized care and treatment with medicines. A strong referral system should be a part of the healthcare and health workers to be properly trained to refer those patients who are in need of special care [1-3].
The authors are extremely grateful to Head of the Department of Community Medicine, Shri Sathya Medical College for his constant support and encouragement.
- Maternal mental health and child health and development in low and middle income countries. Report of the WHO meeting. Geneva, World Health Organization, 2008.
- World Health Organization. Mental health- Maternal Mental Health.
- World Health Organization. Improving maternal mental health.
- 2020 Mom project. About Mental Health disorders.
- Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 20: 189-209. [Crossref]
- Jaime Miranda J, Vikram Patel (2005) Achieving the Millennium Development Goals: Does Mental Health Play a Role? PLoS Med 2: e291. [Crossref]