Maternal Mental Health

Background: Postpartum depression (PPD) is a significant public health concern, particularly in lowresource settings where access to mental health care is often limited. The condition can adversely affect maternal health, infant development, and family dynamics, necessitating effective identification and management strategies. Aim: The study aimed to investigate the prevalence of postpartum depression and assess the effectiveness of management strategies in low-resource settings. Methods: This prospective observational study was conducted at Civil Hospital Kahuta Rawalpindi from October 2023 to September 2024. A total of 80 postpartum women were recruited using purposive sampling. Participants were screened for PPD using the Edinburgh Postnatal Depression Scale (EPDS), and those with positive findings were assessed further through clinical interviews. Management strategies, including counseling and pharmacotherapy, were implemented based on the severity of symptoms, and outcomes were monitored over a six-months period. Results: The prevalence of postpartum depression in the study population was found to be 45%, with a higher occurrence among women with limited social support and financial constraints. Counseling was provided to all diagnosed cases, while 33% required additional pharmacological intervention. After four weeks of management, 75% of participants reported significant improvement in depressive symptoms, with better outcomes observed in those who adhered to the recommended treatment protocols. Conclusion: Postpartum depression was prevalent in a substantial proportion of women in low-resource settings. Tailored management strategies, combining counseling and pharmacotherapy, proved effective in alleviating symptoms. The findings underscore the need for integrating mental health services into maternal care programs in low-resource settings to ensure early detection and intervention for PPD.

The COVID-19 pandemic has altered the normal course of life, with measures to reduce the virus spread impacting motherhood expectations and, in particular, breastfeeding practices. This study aimed to review evidence regarding the impact of COVID-19 on breastfeeding plans and how these relate to women’s psychological outcomes. Searches were conducted on PubMed and Web of Science for studies in English, Spanish, and Portuguese between January 2020 and January 2021. All study designs and pre-prints were considered. Twelve studies were included. Reports suggest that COVID-19 impacts differently on breastfeeding plans, which in turn leads to distinctive mental health outcomes. Positive breastfeeding experiences have been observed when mothers perceive that they have more time for motherhood, which may be associated with better mental health outcomes. Negative breastfeeding experiences have been observed when mothers are separated from their newborns, when mothers struggle with breastfee...

Postpartum psychosis (PPP) is a severe mental health condition associated with childbirth. It is a psychiatric emergency with the risk of suicide and infanticide. Having said that, not all the mothers who kill their babies suffer from this mental illness. Postpartum psychosis is a rare condition and different from postpartum depression or baby blues. While it is rare, it is very dangerous due to the intensity of its symptoms. The severity of the symptoms makes it a psychiatric emergency, yet it is the least understood of all postnatal psychiatric disorders. This paper explores the general understanding of postpartum psychosis, evaluates postpartum psychosis as defense in criminal law, analyzes challenges and the ethical dilemmas it poses for criminal justice system especially of Nepal and advocates for rehabilitation of the women instead of confining her to prison as punishment. The paper revolves around the central dilemma-whether a mother who kills her infant while experiencing postpartum psychosis should be held criminally liable or viewed with compassion due to their mental state.

Aims. There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. Methods. Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. Results. Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 S.D. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ 2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). Conclusions. Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

Epidemiological and animal research shows that disease aetiology often has to be evaluated with a life course perspective, starting as close to the time of conception as possible and, furthermore, that genetic predisposition, environmental exposures and social context have to be considered simultaneously. 1 Exposures during the prenatal and postnatal periods have implications for children's health and may also have implications for morbidity occurring later in life, including obesity and cardiovascular diseases, asthma and allergy, cancer, delayed neurodevelopment, mental illnesses and more. Birth cohort research has a long history in Europe and extensive collaborations have been established. The Rhea cohort is the only pregnancy cohort established and followed up in Greece and one of the very few cohorts in a large area in southern Europe and the eastern Mediterranean where birth cohort research has just started to emerge, and some of the circumstances observed in the Rhea population actually reflect patterns in this wider region. The research team of Rhea study specializes on specific research areas, including obesity, neurodevelopment and child asthma, but also addresses social, environmental and lifestyle factors specific to the Greek society such as use of pesticides, adherence to the Mediterranean diet or psychosocial factors at a time of economic crisis. The name of the cohort 'RHEA' is inspired by 'P ea' the mythological wife of Kronos (Cronus). The Rhea study was established in 2007 in the island of Crete, aiming to recruit a representative sample of motherchild pairs from early pregnancy and to follow them up to young adulthood. The uniqueness of this cohort is that it takes place in the island of Crete where the beneficial effect

This paper concerns future policy development and programs of research for the prevention of mental disorders based on research emerging from fetal and early life programming. The current review offers an overview of findings on pregnancy exposures such as maternal mental health, lifestyle factors, and potential teratogenic and neurotoxic exposures on child outcomes. Outcomes of interest are common child and adolescent mental disorders including hyperactive, behavioral and emotional disorders. This literature suggests that the preconception and perinatal periods offer important opportunities for the prevention of deleterious fetal exposures. As such, the perinatal period is a critical period where future mental health prevention efforts should be focused and prevention models developed. Interventions grounded in evidence-based recommendations for the perinatal period could take the form of public health, universal and more targeted interventions. If successful, such interventions are likely to have lifelong effects on (mental) health.

Accepted for Publication:

The superwoman schema (SWS), rooted in historical racist stereotypes, acts as a sociocultural construct that many Black American women in the U.S. currently adopt, known as the strong Black woman (SBW) stereotype. This SWS, reinforced by racial discrimination, has been identified as a stressor contributing to psychological strain and mental health disorders. Research indicates that the SWS may negatively affect maternal mental health and perinatal outcomes. However, there is a paucity of research focusing on the SWS's impact on pregnant Black American women regarding their psychological health and birth outcomes. Addressing this gap, this study involved 305 African American women aged 21-45 who reported on their SWS endorsement, perceived stress levels during pregnancy, mental health diagnoses, and birth outcomes. Findings revealed a significant correlation between SWS endorsement and increased stress and a diagnosis of anxiety or depression. A higher SWS endorsement and perceived stress were correlated with caring for others and resisting vulnerability, although no direct link was found between SWS endorsement, perceived stress, and delivering a preterm or low birth-weight infant. Further research is necessary on the SWS's adaptive attributes and its archetypic reification in obstetric care. However, these findings underscore the importance of mental health interventions and support systems for pregnant Black American women, especially among unmarried mothers and those with limited education. This study is among the first to contribute to understanding the SWS as a racial stressor and a contributory mechanism to racial disparities in maternal and perinatal health.

This doctoral capstone project undertakes a thorough exploration of postpartum depression (PPD) among young women, aiming to comprehensively analyze its prevalence, risk factors, and socio-cultural implications. PPD is a crucial mental health issue that affects maternal well-being, infant care, and family dynamics. This study seeks to bridge gaps in existing research by delving into the unique challenges faced by young women aged 18-25 during the postpartum period. To achieve this, the study incorporates quantitative and qualitative interviews with a diverse cohort of young mothers.

By examining psychosocial stressors, cultural influences, and systemic barriers, this study aims to shed light on the multifaceted nature of PPD within this demographic. Moreover, it seeks to propose tailored intervention strategies that acknowledge the interplay of factors contributing to PPD in young women. The findings from this study aspire to inform social work practice, policy development, and healthcare interventions that aim to identify, prevent, and treat PPD in young mothers holistically and early. By amplifying the voices of these women and advocating for targeted support systems, this research endeavors to foster a more inclusive and practical approach to mitigating the impact of PPD on both individual well-being and familial relationships.

ObjectivesIt is important to be able to detect symptoms of common mental disorders (CMDs) in pregnant women. However, the expression of these disorders can differ across cultures and depend on the specific scale used. This study aimed to (a) compare Gambian pregnant women’s responses to the Edinburgh Postnatal Depression Scale (EPDS) and Self-reporting Questionnaire (SRQ-20) and (b) compare responses to the EPDS in pregnant women in The Gambia and UK.DesignThis cross-sectional comparison study investigates Gambian EPDS and SRQ-20 scores through correlation between the two scales, score distributions, proportion of women with high levels of symptoms, and descriptive item analysis. Comparisons between the UK and Gambian EPDS scores were made by investigating score distributions, proportion of women with high levels of symptoms, and descriptive item analysis.SettingThis study took place in The Gambia, West Africa and London, UK.Participants221 pregnant women from The Gambia completed b...

This paper explores matrescence as an overwhelming time for the new mother, specifically describing where that overwhelm can be potentially traumatic or transformative. Considerations of altered states of consciousness have examined where these states hinge on being traumatic or generative, yet scarce attention has been given to maternal experience within these studies. Conversely, within maternal mental health, much attention has been given to minimizing overwhelm in the perinatal period, particularly for the child’s sake, such as through mentalization and strengthening a mother’s capacity for reflective functioning to differentiate between self and other. Building on the strengths and limitations of these historical trends, this article uses examples from contemporary literature and clinical experience to discuss the ways in which the perinatal mother experiences altered states of consciousness toward her potential transformation. Matrescence is discussed as similar to other altered states of consciousness where material and metaphysical planes collide, but different in that the maternal experience is also, of necessity, grounded in relationality. I introduce the term matrescent epistemology to describe the unique, relational psychological opportunities a new mother has to access information about themselves, their lineage, and the unseen world in excess of what is typically known.

Common mental disorders such as anx-iety and depression are the third leading causes of disease burden globally for women between 14 and 44 years of age [1]. By 2030, these are expected to rise to first place, ranked above heart disease and road traffic injuries [2]. A recent systematic review reveals that maternal mental disor-ders are approximately three times more prevalent in low- and middle-income coun-tries (LMICs) than in high-income countries (HICs), where the related burden of disease estimates range between 5.2 % and 32.9% [3,4]. In HICs, maternal suicide is the leading cause of death during the perinatal

Alcohol and other drugs (AOD) use among pregnant women have been associated with adverse health outcomes for mother and child, during and after pregnancy. Factors associated with AOD use among women include age, poverty, unemployment, and interpersonal conflict. Few studies have looked at demographic, economic, and psychosocial factors as predictors of AOD use among pregnant women in low-income, peri-urban settings. The study aimed to determine the association between these risk factors and alcohol and drug use among pregnant women in Hanover Park, Cape Town. The study was undertaken at a Midwife Obstetric Unit providing primary-level maternity services in a resource-scarce area of South Africa. 376 adult women attending the unit were recruited and a multi-tool questionnaire administered. Demographic, socioeconomic and life events data were collected. The Expanded Mini-International Neuropsychiatric Interview Version 5.0.0 was used to assess alcohol abuse and other drugs use, depres...

In South Africa, approximately one third of resource-poor women experience mental illness during pregnancy. Prevalence is higher in low-resource settings than in developed countries. The poverty-mental illness cycle is well documented. Through the capabilities approach, this paper locates maternal mental illness in a development framework and explores the deprivational impacts of mental illness. It describes a counselling intervention in South Africa as a case study and applies a qualitative content analysis to descriptive data of a sample of five typical clients. Findings suggest that integrated maternal mental health care may act as a strategic intervention for capability formation and sustainable development.

Background Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women's decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare.

The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system’s responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.

Introduction-Perinatal suicidality, i.e., thoughts of death, suicide attempts, or self-harm during the period immediately before and up to 12 months after the birth of a child, is a significant public health concern. Few investigations have examined the patients' own views and experiences of maternal suicidal ideation. Methods-Between April and October 2010, we identified 14 patient participants at a single university-based medical center for a follow-up, semi-structured interview if they screened positive for suicidal ideation on the Patient Health Questionnaire-9 (PHQ-9) short-form. In-depth interviews followed a semi-structured interview guide. We transcribed all interviews verbatim and analyzed transcripts using thematic network analysis. Results-Participants described the experience of suicidality during pregnancy as related to somatic symptoms, past diagnoses, infanticide, family psychiatric history (e.g., completed suicides and family member attempts), and pregnancy complications. The network of themes included the perinatal experience, patient descriptions of changes in mood symptoms, illustrations of situational coping, and reported mental health service use. Implications-The interview themes suggested that in this small sample, pregnancy represented a critical time period to screen for suicide and to establish treatment for the mothers in our study. These findings may assist health care professionals in the development of interventions designed to identify, assess, and prevent suicidality among perinatal women.

BACKGROUND: Gestational Diabetes Mellitus (GDM) is a common disorder among pregnant women, increasing their vulnerability to psychological stress compared to non-GDM pregnant women. Motherhood is already a significant life-changing and stressful condition. Developing diabetes during pregnancy elevates women's psychological stress levels, leading to pregnancy-related complications and poor neonatal outcomes. This study aims to explore and compare the psychological stress of GDM in pregnant women with non-GDM women.
METHODS: This cross-sectional comparative study investigated diabetes-related distress using the Depression, Anxiety Stress Scale-21 (DASS-21) and the Problem Areas in Diabetes Scale-5 (PAID-5) in purposively selected 75 pregnant women with GDM and compared them to 75 non-GDM women attending antenatal checkups at BIHS General Hospital, Dhaka.
RESULTS: The average age of the pregnant women was 27.71±5.10 (GDM mean= 29.48±4.57, non-GDM mean= 25.95±5.02). Pregnant women with GDM had more stress (57.3%), anxiety (46.7%), and depression (61.3%) compared to non-GDM women (p<.001). According to DASS-21, among all women with GDM, 25.3% had moderate stress, 22.7% mild depression, and 29.3% extreme-severe anxiety. According to the PAID-5 scale, more than half (63%) of the GDM women had diabetes-related emotional distress.
CONCLUSION: Women with GDM are more likely to have psychological distress compared with non-GDM pregnant women. Interventions are needed to improve access to diabetes and mental health care with appropriate tools, such as digital technology-based health interventions.

Maternal mental health problems are experienced frequently in the perinatal period and can be up to twice as common in women from low-and middle-income countries. The terms used to describe mental illness symptoms and the factors that contribute to developing these symptoms are affected by culture and context. Based on 14 focus group discussions held with pregnant women, health professionals and cultural leaders, this qualitative study aimed to understand women's experiences of mental distress during the perinatal period in The Gambia. To do this it aimed to 1) identify the most commonly used idioms of distress, 2) identify the factors believed to affect women's perinatal mental health and 3) explore the role of existing cultural practices, including musical practices, that were identified as locally significant in supporting maternal and mental health. Sondomoo tenkung baliyaa (Mandinka) and xel bu dalut (Wolof) were identified as the most commonly used idioms of distress which roughly translate to lack of a steady mind/heart. Using thematic analysis, six themes (Poverty of the healthcare system, Shifting cultural context, Economic factors, Social factors, Spiritual factors, and Cultural practices involving music) were identified to describe the factors that shape women's experience of mental health during the perinatal period. Lack of economic resources, the prevailing poverty of the health system, an unsupportive husband and spiritual attack by evil spirits or witches were common reasons given for a woman experiencing maternal mental distress. Various existing cultural practices involving music, such as fertility societies, naming ceremonies and community music-making, were recognised as valuable for supporting women's mental health during the perinatal period. This work emphasises that initiatives to support perinatal mental health should be grounded in an understanding of local community cultural practices, knowledge, and experiences.

Background: Pregnant women include a vulnerable population due to various changes that affect their mental health. Mental health problems during the antenatal and postnatal periods affect about one-fifth of pregnant women. Mental illness in pregnant and postpartum women has become a public health concern which has gained attention in recent years. Postpartum depression (PPD) occurring within the first year after delivery, affects 10% to 25% of women globally. Objective: The purpose of this comprehensive systematic review was to evaluate research evidence on the determinants of inherited mental health disorders among before and after pregnancy in Indian women. Methods: Using a systematic literature review of observational studies in English, we focused on Indian women who are evaluated for determinants of inherited mental health problems. PubMed, Google Search, Research Gate, Scopus, Medknow/MedLine and various Journal related to mental health during pregnancy were independently sear...

Perinatal depression (PND) screening recommendations are made by national, state-based and professional organisations; however, there is disagreement regarding screening timing, provider responsible, screening setting, screening tool as well as the follow-up and referral pathways required post-screening. This systematic review aimed to identify, describe and compare PND screening recommendations from member countries of the Organisation for Economic Co-operation and Development (OECD). Publications were identified through systematically searching PubMed, Google and the Guidelines International Network (GIN). Recommendations regarding PND screening endorsement, timing, frequency, responsible provider, tools/assessments and follow-up and referral were extracted. Twenty-one publications, including guidelines, from five countries were included. Most made recommendations in support of PND screening using the Edinburgh Postnatal Depression Scale. Details differed regarding terminology use...

Background: Research on antenatal depressive, anxiety and stress symptoms among women with gestational diabetes mellitus (GDM) is lacking in Malaysia. This study aimed to determine the prevalence and factors associated with antenatal depressive, anxiety and stress symptoms among Malaysian women with GDM. Methods: This was a descriptive, cross-sectional study of 526 women with GDM. Depressive, anxiety and stress symptoms are defined as the final score in mild to extremely severe risk in the severity rating scale. Data analysis was performed using SPSS v.21, while multiple logistic regression was used to identify predictors of depressive, anxiety and stress symptoms. Results: Prevalence of anxiety symptoms was highest (39.9%), followed by depressive symptoms (12.5%) and stress symptoms (10.6%) among women with GDM. According to multiple logistic regression analyses, younger age (OR = 0.955, 95% CI = 0.919-0.993), comorbidity with asthma (OR = 2.436, 95% CI = 1.219-4.870) and a family history of depression and anxiety (OR = 4.782, 95% CI = 1.281-17.853) had significant associations with antenatal anxiety symptoms. Being non-Muslim (OR = 2.937, 95% CI = 1.434-6.018) and having a family history of depression and anxiety (OR = 4.706, 95% CI = 1.362-16.254) had significant associations with antenatal depressive symptoms. Furthermore, being non-Muslim (OR = 2.451, 95% CI = 1.273-4.718) had a significant association with antenatal stress symptoms. Conclusions: Within a population of women with GDM in Malaysia, those at higher risk of having depressive, anxiety and stress symptoms can be identified from several baseline clinical characteristics. Clinicians should be more alert so that the high-risk patients can be referred earlier for further intervention.

IntroductionEmergency caesarean section (ECS) qualifies as a psychological trauma, which may result in postnatal post-traumatic stress disorder (PTSD). Maternal PTSD may not only have a significant negative impact on mother–infant interactions, but also on long-term infant development. The partner’s mental health may also affect infant development. Evidence-based early interventions to prevent the development of postpartum PTSD in mothers are lacking. Immediately after a traumatic event, memory formation is vulnerable to interference. There is accumulating evidence that a brief behavioural intervention including a visuospatial task may result in a reduction in intrusive memories of the trauma.Methods and analysisThis study protocol describes a double-blind multicentre randomised controlled phase III trial testing an early brief maternal intervention including the computer game ‘Tetris’ on intrusive memories of the ECS trauma (≤1 week) and PTSD symptoms (6 weeks, primary outcome) of ...

Supporting caregivers’ mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar–April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children &lt;24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community hea...

Introduction: Women who are impacted by poverty are at heightened risk for depression, yet are unlikely to engage in mental health services due to to practical and perceptual barriers about treatment, including transportation and childcare difficulties, and misperceptions about mental health providers and treatment. The mental health service system has also been shown to limit access due to a lack of providers, extensive wait lists for services, and language barriers. The purpose of this study was to examine agency-level barriers to treatment among a poverty-impacted sample of women with depressive symptoms, as well as any supports that agencies have implemented to engage consumers into services. Method: This study conducted an environmental scan of mental health agencies and practitioners within three districts comprising nine zip codes representing the most socioeconomically disadvantaged areas in Harlem, New York. Following a standardized script, 46 private practitioners (n=27) and agencies (n=19) located within these zip codes provided information about their services, wait times, and any supports they offered consumers to attend. Results: Private practitioners were statistically less likely to accept insurance than agencies, yet agencies had significantly greater waitlists for services, particularly for Spanish-speaking clients. Few private practitioners offered services in Spanish, or offered affordable treatment (less than $100 per session). Only two agencies offered transportation vouchers; no other supports were offered by either private practitioners or agencies. Discussion: Mental health care remains largely inaccessible for mothers living in poverty, particularly if they are Spanish speaking. Systems-level changes are needed in order to provider affordable, accessible treatment and ultimately reduce the risk of maternal depression upon the family.

ABSTRACTMaternal mental disorders can significantly impact on children&#39;s psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother–infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure ...

Background Drastic increases in the rates of maternal depression and anxiety have been reported since the COVID-19 pandemic began. Most programs aim to improve maternal mental health or parenting skills separately, despite it being more effective to target both concurrently. The Building Emotional Awareness and Mental health (BEAM) program was developed to address this gap. BEAM is a mobile health program aiming to mitigate the impacts of pandemic stress on family well-being. Since many family agencies lack infrastructure and personnel to adequately treat maternal mental health concerns, a partnership will occur with Family Dynamics (a local family agency) to address this unmet need. The study's objective is to examine the feasibility of the BEAM program when delivered with a community partner to inform a larger randomized controlled trial (RCT). Methods A pilot RCT will be conducted with mothers who have depression and/or anxiety with a child 6-18 months old living in Manitoba, Canada. Mothers will be randomized to the 10 weeks of the BEAM program or a standard of care (i.e., MoodMission). Back-end App data (collected via Google Analytics and Firebase) will be used to examine feasibility, engagement, and accessibility of the BEAM program; cost-effectiveness will also be examined. Implementation elements (e.g., maternal depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder-7]) will be piloted to estimate the effect size and variance for future sample size calculations. Discussion In partnership with a local family agency, BEAM holds the potential to promote maternal-child health via a cost-effective and an easily accessible program designed to scale. Results will provide insight into the feasibility of the BEAM program and will inform future RCTs. Trial registration {2a} This trial was retrospectively registered with ClinicalTrial.gov (NCT05 398107) on May 31st, 2022.

In the present clinical study the mothers of infant patients with Hyperactivity and Attention Deficit (ADHD) exhibited the followings diseases during pregnancy: Preeclampsia 6%, hyperemesis gravídarum 4%, urinary infections 8%, oligohydramnios and loss of amniotic fluid 2%, abnormal uterine bleeding 2%, aging placenta 2%, placental abruption 3%, high blood pressure 8%, diabetes 4%, prepartum depression 7%, postpartum depression 3%, anxiety, and social problems, such as work, environmental, and conjugal stress. The 100 infant patients examined with Hyperexcitability and Attention Deficit (ADHD) exhibited some of the following associated comorbidities, such as perinatal hypoxia, low weight at birth, behavioural abnormities, anxiety, auto-and hetero aggressivity, autism spectrum disorder, language, learning and hearing disorders, mainly hypoacusia, anorexia or hyperphagia and mental retardation. Social isolation, cognitive deficit, sleeping disorders, talking during sleep, suicidal thoughts, planning and attempts suicidal, parenteral abuse of child. Some non-nervous system co-morbidities, such as pulmonary diseases, and allergic reactions also were found. Some locomotor abnormalities as genus valgo and flat feet were also observed. Preventive interventions suited for the pregnancy period may benefit both maternal and offspring mental health. This line of work should be given high priority on public health research policies mainly in developing countries.

Gestational Diabetes Mellitus (GDM) is a major public health issue and a threat to the well-being of a mother and her offspring. As a growing concern in sub-Saharan Africa, this paper explores the knowledge, attitude, and practices of healthy expectant mothers towards GDM, and the content of GDM information delivered by prenatal nurses during Antenatal Clinic (ANC) in Warri, Delta State, Nigeria. Semi-structured telephone interviews were employed with 22 participants comprising 20 pregnant women and 2 antenatal nurses. The results reveal that majority of the pregnant women were unaware of GDM as a particular health condition during pregnancy that poses a risk to both maternal and infant health and could lead to a long-term risk of developing the chronic condition of Type 2 Diabetes Mellitus (T2DM). This low level of awareness was attributed to a lack of adequate information during prenatal clinic sessions. The findings from this study emphasize the need to enhance the quality of public health education offered to pregnant women during pre and antenatal clinical services emphasizing GDM as part of the overall global agenda on promoting maternal and infant health.

Intimate partner violence during pregnancy (P-IPV) can have significant adverse impacts on both mother and foetus. Existing P-IPV interventions rightly focus on the safety of the mother and reducing re-victimisation; yet expanding these to address the adverse impact on the foetus has considerable potential for preventing long term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes. Using a narrative review of 105 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via keyword searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via five core pathways: maternal stress and mental illness, f...

In developing countries, 15.6% of pregnant women and 19.8% after childbirth experience a mental disorder. In the absence of data on the situation in Cameroon, we carried out a study to determine the prevalence of perinatal mental illness in this hospital and its risk factors among women in perinatal period and the relationship between both at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, a reference mother and child hospital. We conducted a hospital-based, cross sectional, observational study. Data was collected using structured and semi-structured interviews. There were six sub-themes covered: participants’ socio-demographic profile, clinical profile, perinatal history, psychopathology aspects with the Mini International Psychiatric Interview, the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Inventory and the perinatal mental illness risk factors. Data entry was done using Microsoft Excel 2010 and transferred to Statistical Package for the Social Sciences ...

Background: Perinatal depression is defined as a non-psychotic depressive episode occurring during pregnancy or during the first year following childbirth. This depressive disorder is highly prevalent among teenage women but there is a lack of data in low- and middle-income countries. The objective of this study was to provide baseline data on the sociodemographic characteristics of pregnant teenagers or teenage mothers in an urban zone in Yaoundé, Cameroon. Risk factors were assessed, and prevalence of depressive disorders was determined. Methods: Women aged 20 years old or less in the perinatal period were invited to participate in the study. A total of 1344 women participated in the four-stage data collection process involving a questionnaire including questions on sociodemographic background, an assessment of their risk of perinatal depression using the EPDS questionnaire (Edinburgh Postnatal Depression Scale), a clinical interview based on the DSM 5 (Diagnostic and Statistical ...

Background Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. Methods Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. Discussion The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a bene cial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders.

Background Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-...

Hasta la fecha se han realizado escasas investigaciones en España y Latinoamérica que aborden el ajuste psicológico de los prematuros. El presente trabajo examina el ajuste psicológico infantil y algunos factores relevantes para el mismo, en una muestra de niños prematuros españoles. Participantes: 29 menores (Media de edad=36.2 meses, DT=1.42)con antecedentes de prematuridad. El 51.7% fueron niñas. Instrumentos: Se utilizó una encuesta sociodemográfica, el Strengths and Difficulties Questionnaire (SDQ) y la Escala de estrés parental (PSS). Resultados: Entre el 71.4 y el 82.1% de los menores obtuvieron puntuaciones consideradas normales en el SDQ, en el 50% de ellos, sus progenitores indicaron la existencia de algún impacto negativo. No se encuentran relaciones estadísticamente significativas entre las escalas del SDQ y las variables neonatales. Ser español, tener estudios superiores y encontrarse en activo se relacionó con un mejor ajuste psicológico infantil. El estrés parental se...

The need for greater attention to mental health promotion and the prevention of mental disorders in South Africa is highlighted by the cycle of poverty and mental ill-health, the potential for social gains, the question of affordability of treatment in the face of the increasing burden of mental disorders, and the limitations of existing treatment methods. This article, which provides a desk review of the current status of mental health promotion and prevention of mental disorders in South Africa, suggests that South Africa has a number of policies that bode well for promoting mental health from infancy through to old age. There is, however, a need for programmatic interventions to promote resilience in vulnerable populations. Of note, is the need for programmes to address maternal depression and strengthen attachment and psychosocial stimulation during infancy, strengthen families, promote health enhancing school environments, and address intimate partner violence and build health enhancing social capital. Given the multifaceted nature of risk and protective influences, the need for a multi-sectoral plan of action is highlighted.

Objective: To determine the prevalence of gestational diabetes mellitus (GDM) and its associated risk factors among pregnant women in Tuaran District, Sabah State, Malaysia. Material and Methods: A cross sectional analytical study was conducted in Tuaran. Data collection was done by interview method using structured questionnaire and antenatal records review. The study population was all the pregnant women, at and above 24 weeks of gestation who attended the antenatal care clinics in Tuaran District from March to June, 2018. The pregnant women with pre-existing diabetes were excluded from the study. Convenience sampling method was used and 195 pregnant women participated in the study. Descriptive and analytical statistics were done by using SPSS statistical software. GDM has emerged as a major public health concern all over the world. It would develop maternal and foetal adverse outcomes. The prevalence of GDM ranged from 1% to 28% worldwide and from 18.3% to 27.9% in Malaysia. Results: The prevalence of GDM among all participants in Tuaran District was 28.2%. The risk factors significantly associated with GDM were advanced maternal age (p=0.042), presence of family history of diabetes mellitus (p=0.009) and previous history of GDM (p=0.001). Conclusion: The prevalence of GDM among pregnant women in Tuaran District was found to be higher than the previous studies done in Malaysia. Promotion of healthy lifestyle, provision of intense health education, quality antenatal care and early detection with proper management of GDM among pregnant women are crucial for prevention and control of GDM and reduction of adverse maternal and foetal outcomes.

BACKGROUND: The American Academy of Pediatrics (AAP) recommends that pediatric providers screen mothers for postpartum depression at the 1-, 2-, 4-, and 6-month well-child visits. However, compliance with this recommendation varies greatly and is far from 100%. This is significant, as perinatal mood and anxiety disorders (PMADs) represent the most common complication of childbearing. OBJECTIVES: This investigation was conducted to explore barriers to screening in the pediatric setting, reported advantages of screening, providers' knowledge of mental health supports in the community, and commonly observed (and explicitly stated) mental health issues in new mothers. All data collection took place in the state of Georgia, which has the worst rates of maternal mortality and morbidity in the United States. METHOD: A convenience sample of five pediatric practices was selected through the Mercer University School of Medicine's community preceptor network. All clinical staff at each site participated in one of five focus groups for a total of 31 participants. The conversations were audio-taped, transcribed, and thematically analyzed. RESULTS: Providers from two practices were formally screening for Postpartum Depression; they indicated that it added value to their practice. Those not screening cited several barriers including lack of time, training, and access to the mother's medical records. Several clinicians asserted that they were not trained to address mental health issues in their pediatric patients' mothers and that it was out of their realm of expertise. CONCLUSIONS: Provider compliance with the current AAP recommendations may increase with mandatory, specialized training in recognizing and treating PMADs.

This study examined the protective function of mother-adolescent relationship quality in mediating the association between maternal history of violent victimization and adolescent behavior problems. Participants included a subsample of 191 mother-adolescent dyads from the Longitudinal Studies of Child Abuse and Neglect (LONGSC AN) who were at highest risk of child maltreatment. Results revealed that 78.5 % of the mothers reported a history of victimization, which was significantly associated with maternal mental health issues and both adolescent internalizing and externalizing behaviors. Bootstrapping analyses revealed that mother-adolescent relationship quality significantly mediated the relationship between maternal history of victimization and adolescent behaviors.

Objective: Observed associations between maternal prenatal stress and children's socioemotional development have varied widely in the literature. The objective of the current study was to provide a synthesis of studies examining maternal prenatal anxiety and depression and the socio-emotional development of their children. Method: Eligible studies through to February 2018 were identified utilizing a comprehensive search strategy. Included studies examined the association between maternal prenatal depression or anxiety and the future development of their children's socio-emotional development (e.g., difficult temperament, behavioral dysregulation) up to 18 years later. Two independent coders extracted all relevant data. Random-effects meta-analyses were used to derive mean effect sizes and test for potential moderators. Results: 91 effect sizes from 71 studies met full inclusion criteria for data analysis. The weighted average effect size for the association between prenatal stress and child socioemotional problems was OR = 1.66 (95% CI = 1.54-1.79). Effect sizes were stronger for depression (OR = 1.79; 95% CI = 1.61-1.99) compared to anxiety (OR = 1.50; 95% CI = 1.36-1.64). Moderator analyses indicated that effect sizes were stronger when depression was more severe and when socio-demographic risk was heightened. Conclusions: Findings suggest that maternal prenatal stress is associated with offspring socioemotional development, with the effect size for prenatal depression being more robust than anxiety. Mitigating stress and mental health difficulties in mothers during pregnancy may be an effective strategy for reducing offspring behavioral difficulties, especially in groups with social disadvantage and greater severity of mental health difficulties.

Background: There is a large burden of psychological distress in low and middle-income countries, and culturally relevant interventions must be developed to address it. This requires an understanding of how distress is experienced. We conducted a qualitative grounded theory study to understand how mothers experience and manage distress in Dhanusha, a low-resource setting in rural Nepal. We also explored how distressed mothers interact with their families and the wider community. Methods: Participants were identified during a cluster-randomised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Questionnaire (GHQ-12). We conducted 22 semi-structured interviews with distressed mothers (GHQ-12 score ≥5) and one with a traditional healer (dhami), as well as 12 focus group discussions with community members. Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting. Results: We found that distress was termed tension by participants and mainly described in terms of physical symptoms. Key perceived causes of distress were poor health, lack of sons, and fertility problems. Tension developed in a context of limited autonomy for women and perceived duty towards the family. Distressed mothers discussed several strategies to alleviate tension, including seeking treatment for perceived physical health problems and tension from doctors or dhamis, having repeated pregnancies until a son was delivered, manipulating social circumstances in the household, and deciding to accept their fate. Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husbands for resources. Conclusions: Vulnerability, as a consequence of gender and social disadvantage, manifests as psychological distress among mothers in Dhanusha. Screening tools incorporating physical symptoms of tension should be envisaged, along with interventions to address gender inequity, support marital relationships, and improve access to perinatal healthcare.

Background. Depression in mothers during pregnancy and in the postnatal period has been recognised to have wide-ranging adverse impacts on offspring. Our study examines some of the outcomes and long-term economic implications experienced by offspring who have been exposed to perinatal depression. Method. We analysed the effects of perinatal depression on child development outcomes of children at ages 11 and 16 years from a community-based South London Child Development Study. Economic consequences were attached to those outcomes through simple decision-analytic techniques, building on evidence from studies of epidemiology, health-related quality of life, public sector costs and employment. The economic analysis takes a life-course perspective from the viewpoints of public sector, individual and society. Results. Additional risks that children exposed to perinatal depression develop emotional, behavioural or cognitive problems ranged from 5% to 21%. In addition, there was a high risk (24%) that children would have special educational needs. We present results in the form of cost consequences attached to adverse child outcomes. For each child exposed to perinatal depression, public sector costs exceeded £3,030, costs due to reduced earnings were £1,400 and health-related quality of life loss was valued at £3,760. Conclusion. Action to prevent or treat mothers' depression during pregnancy and after birth is likely to reduce public sector costs, increase earnings and improve quality of life for children who were exposed to the condition.

While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socioeconomic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

Katie Rose M Sanfilippo , Vivette Glover, Victoria Cornelius, Rita T Amiel Castro, Bonnie McConnell, Buba Darboe, Hajara B Huma, Hassoum Ceesay, Paul Ramchandani

Objectives: It is important to be able to detect symptoms of common mental disorders (CMDs) in pregnant women. However, the expression of these disorders can differ across cultures and depend on the specific scale used. This study aimed to (a) compare Gambian pregnant women’s responses to the Edinburgh Postnatal Depression Scale (EPDS) and Self-reporting Questionnaire (SRQ-20) and (b) compare responses to the EPDS in pregnant women in The Gambia and UK.
Design: This cross-sectional comparison study investigates Gambian EPDS and SRQ-20 scores through correlation between the two scales, score distributions, proportion of women with high levels of symptoms, and descriptive item analysis. Comparisons between the UK and Gambian EPDS scores were made by investigating score distributions, proportion of women with high levels of symptoms, and descriptive item analysis.
Setting This study took place in The Gambia, West Africa and London, UK.
Participants 221 pregnant women from The Gambia completed both the SRQ-20 and the EPDS; 368 pregnant women from the UK completed the EPDS.
Results: Gambian participants’ EPDS and SRQ-20 scores were significantly moderately correlated (rs=0.6, p<0.001), had different distributions, 54% overall agreement, and different proportions of women identified as having
high levels of symptoms (SRQ-20=42% vs EPDS=5% using highest cut-off score). UK participants had higher EPDS scores (M=6.5, 95% CI (6.1 to 6.9)) than Gambian participants (M=4.4, 95% CI (3.9 to 4.9)) (p<0.001, 95% CIs (−3.0 to –1.0), Cliff’s delta = −0.3).
Conclusions: The differences in scores from Gambian pregnant women to the EPDS and SRQ-20 and the different EPDS responses between pregnant women in the UK and The Gambia further emphasise how methods and understanding around measuring perinatal mental health symptoms developed in Western countries need to be applied with care in other cultures.