Women's Mental Health Services and Pregnancy: A Review

Abstract

Importance: The importance of women's mental health services is becoming more evident as we learn more about the impact of mental health on maternal and perinatal outcomes.Objective: The purpose of this review is to identify the importance of mental health issues arising during pregnancy including prevention, timely diagnosis and treatment, and referral to specialized services.Evidence Acquisition: A literature search was undertaken using the search engines PubMed, CINAHL, and PsycINFO. The search terms were as follows: "mental health services" or "behavioral health" or "mental health counseling" or "psychological" and "delivery of health care" and "pregnancy" or "pregnant." The years searched were January 2000 to November 2020. The search was limited to English language.Results: Of the 255 abstracts identified and reviewed, 35 full-text articles were the basis of this review. Literature summarizing the availability and models of care for mental health services for pregnant women is limited. After reviewing the literature, the themes of depression and anxiety in the antepartum and postpartum periods that emerged as mental health issues, especially during adolescent pregnancies, the coronavirus pandemic, intimate partner violence, and pregnancy loss, are of primary importance to obstetrical providers. All of these issues can have a significant impact on maternal and neonatal outcomes and should be addressed during routine practice.Conclusions and Relevance: Maternal mental health is garnering deserved attention and has enormous implications on maternal and infant outcomes. Obstetrical providers should be comfortable with screening, identification, and basic treatment algorithms including when to refer to specialized services.Relevance Statement: Mental health issues during pregnancy and the postpartum period can be profound with severe maternal and perinatal consequences.Target Audience: Obstetricians and gynecologists, family physicians, psychiatrists.Learning Objectives: After completing this activity, the learner should be better able to identify the mental health services that are available for pregnant women; outline the common mental illnesses that are present during adolescent pregnancies; explain the risk factors that have been linked with perinatal depression; and describe the management and potential complications of pregnant patients presenting with mental illness.

Depressive symptomatology in pregnant adolescents: considerations for care

“…at every pregnancy encounter). This is important, given the higher prevalence of depressive symptoms among pregnant adolescents [6,[9][10][11] and the significant clinical consequences (e.g. suicidality) for this population, relative to adults [8 && ].…”

“…Demographic Low-income level [8 && ,17,18] and/or not currently employed [16] and/or not currently housed [20 & ] and/or food insecurity [16] Low levels of educational attainment [18,19] Not currently in a relationship [16,19] Younger age [16] Psychosocial History of childhood abuse and/or neglect [18] Lifetime exposure to racial/ethnic discrimination [21 & ,22,23,24] Prepregnancy history of depressive symptoms [6] Current or recent history of abuse and/or neglect, including IPV [15,21 older, partnered, employed, or food secure [16,19,20 & ]. Adolescents who report lower levels of income likely experience competing demands throughout pregnancy (e.g.…”

“…Adolescents who are pregnant and have a history of psychopathology and/or exposure to trauma and adversity are at particular risk of experiencing depressive symptoms. One of the best predictors of prenatal depressive symptomatology is a prepregnancy history of depressive symptoms [6]. In addition, adolescents who report a history of emotional, physical, or sexual abuse and/or neglect during childhood are more likely to experience prenatal depressive symptoms than adolescents without a history of childhood maltreatment [18].…”

“…The combined effects of pregnancy during adolescence confer additional risk for depressive symptomatology. Pregnant adolescents experience higher levels of depressive symptoms, relative to nonpregnant peers [7] and pregnant adults [6,8 ▪▪ ,9–11]. Pediatric clinicians are likely the first point of clinical contact for pregnant adolescents [12 ▪ ].…”

How do prenatal people describe their experiences with anxiety? a qualitative analysis of blog content

“…During pregnancy, anxiety increases cortisol in the mother’s blood for prolonged periods, raising the risk of harmful outcomes such as spontaneous abortion and preterm labour [ 13 – 16 ]. Beyond pregnancy, anxiety may be linked to cognitive, behavioural, and emotional problems in the infant as they grow older, in addition to increasing the risk for maternal postpartum mental health concerns (e.g., postpartum anxiety or depression) [ 17 – 19 ]. Despite the prevalence and severity of perinatal anxiety (anxiety occurring in pregnancy and up to 12 months postpartum), postpartum depression is the only perinatal mental health condition classified in the DSM-5.…”