(CNN)– Postpartum depression (PPD) is estimated to affect more than one in ten women having a baby and is just one of many mood disorders a woman can experience during pregnancy or in the first year after childbirth known as the perinatal period.
Yet these conditions, known as perinatal mood disorders, remain largely misunderstood by the public and health professionals, experts said at a roundtable organized by the CNN As Equals gender reporting team. .
Following CNN’s reporting of a family’s tragic experience with postpartum depression, which had a huge impact on the audience, As Equals brought together an international group of people with experience and expertise in maternal mental health to discuss the true prevalence of postpartum depression. these disorders, their underlying causes, the problems in diagnosing and treating them, and finally, possible solutions.
A “lack of appreciation” for mental health in motherhood
The conversation began with the panelists stating that the number of women affected by perinatal mood disorders is probably much higher than one in 10, and they unanimously agreed that the topic continues to be neglected by health services in everyone.
“There is still a widespread concept that mental health is a luxury,” said Simone Honikman, founder and director of the Perinatal Mental Health Project in Cape Town, South Africa.
She explained that a woman’s mental health not only affects her physical health, but also that of her baby, directly or indirectly, because when she has a mental health problem, she may not seek other crucial health services. for her or for the welfare of her child.
“There is little appreciation of the fact that these mental health conditions have a direct impact on physical health conditions and are highly correlated with a range of physical health considerations, whether it be service uptake, health-seeking behaviour, premature birth, low birth weight, stunted growth of babies, use of assisted antiretroviral therapies or other forms of treatment,” Honikman said.
Kazione Kulisewa, a consultant psychiatrist at Kamuzu University of Health Sciences in Malawi, agreed that mental health takes a backseat to other physical conditions, but explained that in countries like Malawi, where there are multiple With competing health priorities and very limited resources, it is even more difficult to push for investment in maternal mental health care when there are such high rates of HIV and maternal mortality. (In Malawi, an estimated 10% of women aged 15-49 were living with HIV in 2020, and this southern African country has one of the highest maternal mortality rates in the world, with 439 maternal deaths for every 100,000 live births (in the United States this figure is 23.8 per 100,000).
Despite these challenges, Kulisewa was emphatic: “Mental health conditions, when left untreated, cause a greater burden than some of the infectious diseases,” he said.
The repercussions of this neglect of perinatal mood disorders are enormous. A World Health Organization (WHO) study found that women with postpartum depression were twice as likely to have depression four years later and were significantly more likely to have chronic illness. Studies have also shown the relationship between the mental health of mothers and the health of their children.
We are not preparing women
For Jen Schwartz, CEO of Motherhood Understood, a US-based organization that connects and educates women about perinatal mental illness, the biggest concern is stigma and lack of awareness.
Schwartz herself suffered from severe postpartum depression and anxiety following the birth of her son nine years ago and remembers feeling uninformed, isolated and ashamed. She believes that by not educating and supporting women more openly about mental health conditions during pregnancy and motherhood, “we are not preparing women to know what to look for and to know that something is wrong.”
“I think the consequences of this are tremendous,” Schwartz said, explaining that the resulting isolation makes women feel unable to talk about how they feel. “You don’t speak and you suffer in silence,” she said.
Lack of informed professionals, at all levels
The experts also acknowledged the lack of professionals working in the sector, such as psychologists and perinatal therapists specialized in maternal mental health, but also midwives and antenatal care providers with knowledge in this field, so that they know what symptoms to look for. As an example, Kulisewa pointed out that there were only three perinatal psychiatrists in Malawi, which has a population of 19 million. CNN was unable to contact the Malawi Ministry of Health to confirm this.
However, there was also unanimous agreement on the panel that community organizations are also crucial.
Dr Prabha Chandra’s team from the National Institute of Mental Health and Neurosciences in India worked with women and communities in Karnatika state to test various interventions with mothers, as well as talking with husbands and mothers-in-law. about what depression and anxiety are like, as these relationships play an important role in the well-being of new mothers in India.
Chandra stressed the need to find culturally appropriate ways to raise awareness of maternal mental health, such as simplified diagnostic methods and locally produced films and materials that take into account local sensitivities and communicate in a way that people can understand.
The need for systemic change
Having established the many challenges: limited resources, lack of qualified personnel, consistent data collection around the world, competing public health needs, persistent stigmatization and shame, inadequate understanding of the magnitude and impact of the problem both among both in legislators and in the general population, the debate turned to consider solutions, and those that could bring about systemic change.
A critical part of the solution is to better integrate maternal mental health services into a country’s existing health infrastructure, such as antenatal services or child development programs. Many of the panelists said that this integration is essential so that funding or support for maternal mental health services is not dependent on political support and can survive changes in leadership, which around the world bring about changes in public health priorities.
This integration has been achieved in many high-income countries, said Jane Fisher, Professor of Global Health at Monash University. “There is public recognition, but it has required substantial investment in public education, health care, vocational training and the creation of tiered services,” she said.
But it will be some time before this is achieved in low- and middle-income settings.
Another important solution that was proposed was the need to adapt the standard tool used worldwide to detect mental health problems in the perinatal period, the Edinburgh Postnatal Depression Scale, created more than 30 years ago. The WHO says the scale should be used as a starting point and not as a diagnostic tool, and experts on the panel agreed, but said a universal test like this doesn’t work well in practice.
“There is a strong need for tools to be developed from the specific context of each country, using local idioms,” Honikman explained. He described the Edinburgh scale as too long and complicated for use by busy midwives caring for thousands of women, and thought the language used was inappropriate for the communities his team works with. Therefore, they have created their own detection tool, shorter and in three local languages.
Looking at other solutions, others spoke of the need for increased awareness and knowledge of mental health among the public, politicians and health professionals to have a real impact, and finally more funding and financial support.
Missed opportunities for prevention
A final point raised by Chandra and others was the opportunity for prevention. If health systems address maternal mental illness risk factors early, the onset of the disorder can be prevented. These risk factors include poverty, domestic violence and childhood trauma, and are likely to be higher in countries that rank lower on the gender equality index, such as India, Chandra explained.
Women who experience intimate partner violence during pregnancy are estimated to be three times more likely to develop postpartum depression, and studies show that the disorder is two to four times more likely in women living in poverty.
“If domestic violence is reduced […] and poverty in families is reduced, much more can be achieved in terms of reducing mental health problems than a million psychiatrists will ever achieve,” said Alain Gregoire, co-founder of the World Alliance on Maternal Mental Health.
For an hour and a half, the various experts spoke passionately about the needs of new mothers and expressed their frustration that more is not being done for maternal mental health, given what is known about their prevalence and the steps needed, often simple, to reduce it.
In closing, Schwartz reiterated a connection that had been made earlier in the discussion; pointing simply to those leaders who care about the well-being of children, but perhaps see the well-being of the mother as less of a priority: “Caring for the mother and taking care of her mental health [es] the best way to take care of your baby.
If you or someone you know may be at risk for perinatal mood disorder, here are ways to help.
If you’re in the United States, you can call the ISP Helpline at 1-800-944-4773 or text “Help” to 800-944-4773. To find support in other countries, see a list of providers here. To join an online support group, click here.