Burden of severe maternal peripartum mental disorders in low- and middle-income countries: a systematic review

Abstract

Peripartum severe mental disorders (PSMDs) encompass schizophrenia, affective psychosis, and psychotic and non-psychotic forms of bipolar disorders. PSMDs are well documented in high-income countries. However, much less is known about the prevalence of PSMDs in low- and middle-income countries (LMICs). The aim was to review the available literature systematically and estimate the prevalence of PSMDs among women in LMICs. We searched the Ovid MEDLINE, Embase, PsycINFO, CINAHL and Maternity and Infant Care databases systematically from the date of inception to Dec 31, 2020, for English-language publications with data on the prevalence of PSMDs among women in World Bank–defined LMICs. Selection of studies, extraction of data and assessment of study quality were each undertaken independently by at least two of the investigators. A total of five studies (completed in three countries spanning two continents) met the inclusion criteria. Five studies reported cumulative incidence of postpartum psychosis (ranging from 1.1 to 16.7 per 1000 births). We found no studies on the prevalence of severe mental disorder during pregnancy in these settings. Marked heterogeneity in methodology precluded meta-analysis. These findings indicate that PSMDs occur at a similar prevalence in low- and middle-income to high-income countries. However overall, there is a paucity of high-quality evidence from these settings. There is a need for rigorous studies with standardized methods to increase knowledge of the nature, prevalence, and determinants of PSMDs among women in resource-constrained LMICs to inform policies, service development, program planning and health professional training.

Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward

“… 64 A separate systematic review (five studies in LMICs) reported a cumulative incidence of postpartum psychosis of 1·1 per 1000 births, and the prevalence between studies ranged from 1·1 to 16·7 per 1000 births. 65 Anxiety disorders A systematic review reported that the pooled prevalence of postpartum anxiety disorder was 16% (95% CI 13·5–18·9) and of self-reported anxiety symptoms was 24·4% (16·2–33·7). 66 A separate systematic review reported the pooled prevalence of postpartum anxiety disorder was 9·6% (3·4–15·9) at 5–12 weeks postpartum, 9·9% (6·1–13·8) at 1–24 weeks postpartum, and 9·3% (5·5–13·1) at over 24 weeks postpartum.…”

Marital and family relationships among women with severe mental illness during perinatal period admitted to a mother baby psychiatric unit, India

“…3 In low and middle-income countries, the cumulative incidence of peripartum severe mental disorders ranged from 1.1 to 16.7 per 1000 births. 5 The relationship between marriage and mental illness is complex. Marriages in India are usually arranged by parents and are influenced by several factors such as astrological compatibility, caste regulation, geographic proximity, socio-economic equivalency, prescribed values, and expectations of dowry, it is not just a tie of two human beings but establishes as a constellation of many other relationships surrounding the couples.…”

Global Peripartum Mental Health

“…Implementation of evidence-based interventions for reduction of common perinatal mental disorders is essential for women who are often suffering in silence (McNab et al, 2022). They should be integrated into peripartum health care (Kalra et al, 2022), with group care models such as Centering Pregnancy, which has shown to be an effective approach making an important difference. Midwife caseload models are proving effective globally, particularly for childbearing and childrearing women living in LMICs (Michel-Schuldt et al, 2020).…”

“…Identification of and attention to social determinants of health in peripartum women is critical. Social determinants of health include cultural and social context, race and ethnicity, lack of social support, financial and nutritional insecurity, substance use, gender inequities, intimate partner violence, and a paucity of appropriate health care resources (Kalra et al, 2022; McCarthy et al, 2021; McNab et al, 2022; Ruyak & Kivlighan, 2021).…”

“…Systematic reviews document current evidence and provide recommendations for interventions to strengthen health and wellbeing of peripartum women, especially those living in LMICs. In a systematic review of peripartum mental health issues, no assessment treatment guides were found to facilitate care for women living in LMICs (Kalra et al, 2022). Implementation of evidence-based interventions for reduction of common perinatal mental disorders is essential for women who are often suffering in silence (McNab et al, 2022).…”