The silent burden: a landscape analysis of common perinatal mental disorders in low- and middle-income countries

Abstract

Background Mental health has long fallen behind physical health in attention, funding, and action—especially in low- and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs. Methods The landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scopus. Titles and abstracts were reviewed before a multidisciplinary team conducted data extraction and analysis on relevant articles. Second, 44 key informant interviews and two focus group discussions were conducted with mental health, MNCAH, humanitarian, nutrition, gender-based violence (GBV), advocacy, and implementation research experts. Finally, reviewers completed a document analysis of relevant mental health policies from 19 countries. Results The LA identified risk factors for CPMDs, maternal mental health interventions and implementation strategies, and remaining knowledge gaps. Risk factors included social determinants, such as economic or gender inequality, and individual experiences, such as stillbirth. Core components identified in successful perinatal mental health (PMH) interventions at community level included stepped care, detailed context assessments, task-sharing models, and talk therapy; at health facility level, they included pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with GBV services. Yet, significant gaps remain in understanding how to address CPMDs. Conclusion These findings illuminate an urgent need to provide CPMD prevention and care to women in LMICs. The time is long overdue to take perinatal mental health seriously. Efforts should strive to generate better evidence while implementing successful approaches to help millions of women “suffering in silence.”

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

“…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].…”

A Theoretical FRAMEWORK for the Development of Perinatal Period Mental Health Guidelines in Zimbabwe

“…"Psyche" includes contemplations, feelings, convictions and mental pictures. Brain to bodily intercessions have been proven to help in diminishing tension and improving by and large the state of mind in perinatal ladies [30,31]. Psyche and body approaches, for example, yoga, reflection and breathing activities may likewise assist with improving birth weight and diminish premature births.…”

Global Peripartum Mental Health

“…Community-based interventions recommended in multiple systematic reviews include pharmacotherapy, referral for stepped health care (progressive mental health services), detailed context assessments (evaluating the context of women's lives), task-sharing models, and talk therapy. Health facility interventions include mental health education and support for providers, sensitive referral and assessment, and most importantly respectful and culturally appropriate care for childbearing women and their families (McNab et al, 2022). Attention to the complex relationship between social determinants of health and the mental health of peripartum women is critical.…”

“…There is mounting concern about the increasing incidence of global common perinatal mental disorders and severe peripartum mental disorders in low- and middle-income countries (LMICs), described as “the silent burden” of childbearing and childrearing women (McNab et al, 2022, p. 342). In a synthesis of studies of the perceptions of peripartum women with mental health disorders, themes included: the relationship between social support and experiencing anxiety and depression; experiences of positive or negative health care, social norms and expectations that have an impact on coping; and maternal–newborn health factors (McNab et al, 2022). Identification of and attention to social determinants of health in peripartum women is critical.…”

“…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).…”