Are we overlooking the obvious? Addressing social determinants of health that contribute to perinatal depression

Abstract

Mental health disorders among women during the perinatal period are common and cause significant morbidity, yet precise reasons why some women develop depression during this period, and others do not, are, as yet, unknown. Pregnancy may burden populations of women differently, and sociological variables, such as finances, social position, interpersonal resources; and extreme events, the coronavirus disease 2019 (COVID-19) pandemic for example, may be as significant as biological determinants. However, current treatment for depression remains focused on the individual woman as the main agent for change. Incorporating a systems-wide approach to diagnosing and treating perinatal depression by addressing structural and systemic determinants may be a more effective way to treat this illness. In this paper, we explore social determinants of health and their correlation with clinical depression in the antenatal period. We also investigate broader, society-wide interventions that may reduce this significant morbidity among women of reproductive age, in both developed and developing nations.

The global burden of perinatal depression: A call to action

“…[9,16] For instance, a systematic review including 37 studies and data from over 4,000 women found that 20% women with pre-existing bipolar disorder experienced a severe postnatal mental illness, including psychosis, mania, and/or hospitalization [17]. Often overlooked in the narrative of perinatal depression are the structural and social determinants such as poverty, education level, intimate partner violence, chronic stress from lower welfare support, poor social support, relationship factors, unemployment, neighborhood socio-economic status [18,19]. In addition, in certain regions such as South America and Africa, ethnicity has also been identified as a risk factor [18].…”

“…Often overlooked in the narrative of perinatal depression are the structural and social determinants such as poverty, education level, intimate partner violence, chronic stress from lower welfare support, poor social support, relationship factors, unemployment, neighborhood socio-economic status [18,19]. In addition, in certain regions such as South America and Africa, ethnicity has also been identified as a risk factor [18]. In South Asia and the Middle East, rigid cultural gender norms such as pressure to have a male child is also associated with PND [20,21].…”

The role of primary care in optimising women’s sexual and reproductive health

“…Given the central role of primary care to women's health and wellbeing, we put together this special issue to explore the ways in which primary care settings and practitioners can optimise women's sexual and reproductive health. The papers in this special issue explore a range of issues and opportunities across the spectrum of sexual and reproductive health, including in relation to contraception access (Dev et al 2023;Li et al 2023;Mazza et al 2023); support for unintended pregnancies (Noonan et al 2023); abortion care (Haas et al 2023;Srinivasan et al 2023); preconception, pregnancy, postpartum and interconception care (Fitch et al 2023, Li et al 2023Simhi and Yoselis 2023;Withanage et al 2023;Thomas et al 2023;Yussf et al 2023); and issues relating to informed consent (Power et al 2023). The special issue takes a reproductive life course perspective through consideration of both pregnancy prevention and pregnancy preparation (Hall et al 2023).…”

“…Mental health disorders among women during the perinatal period are common yet it is not known why some women develop depression during this period. In their narrative review, Simhi and Yoselis (2023) explore social determinants of health and their correlation with clinical depression in the antenatal period, suggesting that the mental health of high-risk pregnant women could be better supported by improving socio-economic conditions and facilitating integration of women fully within the social construct. In relation to provision of perinatal services for the prevention of vaccine-preventable diseases, Yussf et al (2023) report on the barriers to optimal care delivery and the need for coordinated and standardised systems, including training and education for health practitioners, improved data collection, and communication among health services.…”