Comment: silent burden no more: a global call to action to prioritize perinatal mental health

McNab, Shanon; Fisher, Jane; Honikman, Simone; Muvhu, Linos; Levine, Rebecca; Chorwe‐Sungani, Genesis; Bar-Zeev, Sarah; Hailegebriel, Tedbabe Degefie; Yusuf, Ifeyinwa; Chowdhary, Neerja; Rahman, Atıf; Mershon, Claire-Helene; Bormet, Mona; Henry-Ernest, Diana; Portela, Anayda; Stalls, Suzanne

doi:10.1186/s12884-022-04645-8

Cited by 21 publications

(16 citation statements)

References 16 publications

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“…This action should draw on local evidence for sustainable mental health financing strategies (Docrat et al ., 2019b ), national and international policies, such as the National Mental Health Policy Framework and Strategic Plan (Department of Health, 2013 ), South African Maternal, Perinatal and Neonatal Health Policy (Department of Health, 2021 ), WHO guidance on maternal mental health and early child development (WHO, 2008a , 2014 , 2020 ) and by reference to the UN Sustainable Development Goals (WHO, 2008b ). Intersectoral, collaborative and community-based strategies are needed to promote perinatal mental health by addressing social determinants of mental illness (such as gender-based violence, poverty, social isolation and obstetric violence), reducing mental health stigma, increasing demand for and promoting the uptake of care (Rahman et al ., 2013 , Atif et al ., 2015 , Lund et al ., 2018 , Macnab et al ., 2022 ). Implementation strategies should include competency-based training, supervision and support for maternity staff and other frontline providers to provide primary-level mental healthcare (Honikman et al ., 2012 , Lund et al ., 2014 , Howard et al ., 2014 , WHO, PEPFAR & UNAIDS, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

Costs of common perinatal mental health problems in South Africa

et al. 2022

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Background Perinatal mental health problems, defined as mental health problems occurring from the start of pregnancy to one year after birth, substantially affect women's and children's quality of life in low- and middle-income countries. In South Africa, despite high prevalence and documented negative impacts, most women do not receive any care. Methods A modelling study examined the costs of perinatal mental health problems, namely depression and anxiety, for a hypothetical cohort of women and their children in South Africa over part of their life course (10 years for women, 40 years for children). In sensitivity analysis, additional impacts of post-traumatic stress disorder (PTSD) and completed suicide were included. Data sources were published findings from cohort studies, as well as epidemiological and economic data from South Africa. Data from international studies were considered where no data from South Africa were available. Results Lifetime costs of perinatal depression and anxiety in South Africa amount to USD 2.8 billion per annual cohort of births. If the impacts of PTSD and suicide are included, costs increase to USD 2.9 billion. This includes costs linked to losses in quality of life (USD 1.8 billion), losses in income (USD 1.1 billion) and public sector costs (USD 3.5 million). Conclusions Whilst important progress has been made in South Africa with regards to mental health policies and interventions that include assessment and management of perinatal mental health problems, substantial underinvestment prevents progress. Findings from this study strengthen the economic case for investing in perinatal mental health care.

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Section: Discussionmentioning

confidence: 99%

Costs of common perinatal mental health problems in South Africa

et al. 2022

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“…Two systematic reviews of qualitative data are included; one summarises perceptions and attitudes around perinatal mental health in Bangladesh, India and Pakistan [27], while the other provides a qualitative evidence synthesis of data about women's experiences and perceptions of anxiety and stress [28]. McNab et al [29] present a 'landscape analysis' to assess the state of common perinatal mental disorders and strategies to address these in lower and middle income countries, and then call on the international community, government and health systems to act urgently to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing [30].…”

Section: Rationale For This Collectionmentioning

confidence: 99%

Maternal mental health: Women’s voices and data from across the globe

Redshaw

Wynter

2022

BMC Pregnancy Childbirth

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“…This was despite that trained nurses administered the EPDS questionnaire. Additionally, it has been speculated that women with lower education status and mostly poor do not regard psychological problems as health problems and mostly because of fear of being stigmatized they do not disclose their mental illness to others [15].…”

Section: Factors Early Ppdmentioning

confidence: 99%

“…The World Health Organization recommends screening for perinatal depression with referral and management services where needed [1]. This recommendation has recently been backed with a global call to action to prioritise perinatal mental health arguing that unless maternal mental health is taken as seriously as their physical wellbeing, maternal morbidity, mortality and the ability of the women to thrive will not be improved [15]. However, it remains unknown whether universal screening for maternal depression after childbirth improves clinical outcomes and whether it is feasible especially in LMICs where human work force is not adequate [3,13].…”

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confidence: 99%

Prevalence of early postpartum depression and associated risk factors among selected women in southern Malawi: a nested observational study

Moya

Mzembe

Mwambinga

et al. 2022

Preprint

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Background The birth of a child should be a time of celebration. However, for many women, childbirth represents a time of great vulnerability to becoming mentally unwell, a neglected maternal morbidity. This study aimed to determine the prevalence of early postpartum depression (PPD) and its associated risk factors among women giving birth at health facilities in southern Malawi. Identifying women vulnerable to PPD will help clinicians provide appropriately targeted interventions before discharge from the maternity ward. Method We conducted a nested cross-sectional study. Women were screened for early PPD using a locally validated Edinburgh Postpartum Depression Scale (EPDS) as they were discharged from the maternity ward. The prevalence of moderate or severe (EPDS ≥ 6) and severe (EPDS ≥ 9) PPD was determined, including 95% confidence intervals (CI). Data on maternal age, education and marital status, income source, religion, gravidity, and HIV status, among others, were collected during the second trimester of pregnancy, and obstetric and infant characteristics during childbirth were examined as potential risk factors for early PPD using univariable and multivariable logistic regression analyses. Results Data contributed by 636 women were analysed. Of these women, 9.6% (95% CI; 7.4–12.1%) had moderate to severe early PPD using an EPDS cut-off of ≥ 6, and 3.3% (95% CI; 2.1–5.0%) had severe early PPD using an EPDS cut-off of ≥ 9. Multivariable analyses indicated that maternal anaemia at birth (aOR; 2.65, CI; 1.49–4.71, p-value; 0.001) was associated with increased risk for moderate and/or severe early PPD, while live birth outcome (aOR; 0.15, 95% CI; 0.04–0.54, p-value; 0.004), being single compared to divorced/widowed (aOR; 0.09, 95% CI; 0.02–0.55, p-value; 0.009), and lower education level (aOR; 0.36, 95% CI; 0.20–0.65, p-value; 0.001) were associated with decreased risk. Being HIV positive (aOR; 2.88, 95% CI; 1.08–7.67, p-value; 0.035) was associated with severe PPD only. Conclusion The prevalence of early PPD was slightly lower in our selected sample compared to previous reports in Malawi and was associated with maternal anaemia at birth, non-live birth, being divorced/widowed and HIV-positive status. Therefore, health workers should screen for depressive symptoms in women who are at increased risk as they are discharged from the maternity ward for early identification and treatment.

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Comment: silent burden no more: a global call to action to prioritize perinatal mental health

Cited by 21 publications

References 16 publications

Costs of common perinatal mental health problems in South Africa

Costs of common perinatal mental health problems in South Africa

Maternal mental health: Women’s voices and data from across the globe

Prevalence of early postpartum depression and associated risk factors among selected women in southern Malawi: a nested observational study

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