Download - Maternal depression HEART Reading Pack
Maternal Mental Health: Overview of the HEART Reading Pack
Prof Crick LundDepartment of Psychiatry and Mental Health
University of Cape TownEmail: [email protected]
What is depression?1
Core requirements:• Depressed mood (feels sad, empty or hopeless)• Loss of interest and enjoyment/pleasure• Reduced energy leading to increased fatigue and diminished activity. Plus 3 or more of the following: significant weight gain/loss; insomnia/hypersomnia; psychomotor agitation/retardation; feeling excessively worthless/guilty; diminished ability to think/concentrate; recurrent thoughts of death/suicideNote: • Symptoms must cause clinically significant distress or impairment in
social, occupational or other important areas of functioning• Symptoms must persist for at least a 2 week period (major depressive
episode)
1. DSM-5, American Psychiatric Association, 2013; ICD-10, WHO, 2010
What is maternal depression?
• Depression experienced by a mother during pregnancy or the postnatal period (first 12 months of her baby’s life)
• The experience of maternal depression may vary substantially across cultures, and is expressed in various idioms of distress, e.g.:– kufungisisa “thinking too much” in Zimbabwe– ukudakumba “being sad or unhappy” and ucingakakhulu
“thinking too much” in South Africa– yandimukuba “being struck by pressure” in Uganda
Why should we treat maternal depression?
The burden of Common perinatal mental disorders (depression and anxiety) is high:
– High income countries: 13% (antenatal); 10% (postnatal)
– Low and middle-income countries: 16% (antenatal) ; 20% (postnatal)
Fisher et al 2012
Photo: Alexia Beckerling
Why should we treat maternal depression?Prevention: intergenerational impact
Antenatal distress Postnatal distress• Chronic mental illness• Drugs / alcohol• Suicide/Infanticide
ChildInfancy• Emotional
problems• Cognitive
problems• Poor growth• Diarrhoeal
disease• Malnutrition
Childhood / Adolescence• Mental health problems• Impaired mother-child
relationships
Mother
Poor bonding
Dysfunction may influence
the next generation
Trans-placental
Risk Factors
Why should we integrate?The good news
• Unique opportunities for health system contact with mothers– Antenatal Care– Postnatal Care
• Evidence for effective treatment– Low resource settings (India, Pakistan, Chile) –
WHO Thinking Healthy Manual– The Perinatal Mental Health Project model
(South Africa) • Efficient investment for child outcomes
(Heckman’s model)
Investment hypothesis
Investing in Early Human Development: Timing and Economic Efficiency Orla Doyle, Colm P. Harmon, James J. Heckman,and Richard E. Tremblay Econ Hum Biol. 2009 March; 7(1): 1–6.
Steps to integrating mental health care into routine maternal health care • Select a suitable locally relevant screening or
detection tool. • Adapt and translate the screening tool if
necessary.• Conduct a needs assessment.• Based on the identified need, design a
stepped care approach, appropriate to local setting:– Step 1: Routine or selected antenatal and
postnatal screening– Step 2: Screen positives referred for evidence-
based counseling– Step 3: Referral of mothers who are not
responsive to counseling for assessment by medical doctor for potential anti-depressant medication.
Photo: PMHP
Cautionary notes
• Consider options for screening tools carefully.
• 5-day training using the WHO Thinking Healthy manual
• Ongoing supervision of counselors is essential!
• Select counselors carefully based on:– Personal capacity for empathy– Motivation– Skills