Cape Town - Pregnant women should be screened for depression and anxiety during and after their pregnancies, says the Perinatal Mental Health Project (PMHP) based at UCT.
Working with the departments of health and social development, this not-for-profit organisation is involved in raising awareness as well as advocating for the screening for, and provision of, mental health care for mothers and moms-to-be.
Founded in 2002 by medical doctor Simone Honikman, the project first offered its services at Mowbray Maternity Hospital. Since then, it has spread to the Hanover Park Midwife Obstetric Unit and False Bay Hospital. In addition to clinical services, it has three other programmes: research; training and development; and advocacy, communications and policy.
Bronwyn Evans is a trained clinical psychologist and worked in the mental health sector for 13 years before joining the project in 2008.
"We are advocating for maternal mental health services to be integrated routinely into public service platforms both health and social. Our mission includes raising awareness regarding mental distress in the perinatal period and also training, developing and capacity building to enhance the responsiveness of care providers to women with, or at risk of, perinatal mental illness," she said.
Perinatal mental illness is significant emotional distress that occurs any time from the time of conception to the end of the baby's first year, and lasts for more than a few weeks.
"It affects how a woman feels, thinks, behaves, cares for her baby and interacts with those around her," said Evans.
"Sometimes the effects can even continue after this period, especially if it is left untreated. The common perinatal mental disorders are anxiety and depression, which are common among people generally. However, being pregnant and having a baby is one of those more vulnerable times in our lives, and so women may be more at risk during this period.
"Other serious disorders, such as bipolar disorder or other psychotic disorders, may also occur in the perinatal period, but they are much more rare," she said.
Prenatal (or antenatal) maternal stress occurs during pregnancy, when the expectant mom is exposed to stress. It is a generic term and does not necessarily refer to "illness". Under certain circumstances, stress may develop into perinatal mental illness, if mothers can't get help or change their situation.
"Unfortunately, mental illness is not always detected, unless somebody asks for help or a family member or health-care providers ask the right questions. It is not something you can obviously see like many physical problems. This results in many people unnecessarily suffering in silence," said Evans.
"Also, after the birth of a baby, people may be more focused on the baby than on how the mother is feeling. By integrating mental health care into maternity and social services, we can ensure that questions are asked which will help identify women in distress, or at risk of developing mental illness.
"We ask questions about mood (how a woman has been feeling over a recent time period), functioning (at home, at work/school and in relationships), and we ask about risk factors we know can predispose women to mental illness during this time, such as intimate partner violence, lack of support, or being diagnosed HIV positive."
Common symptoms for depression include: feeling very down or hopeless, having little interest or pleasure in doing things that are normally pleasurable, feeling tired, sleeping too much or too little, eating too much or too little, and even feeling suicidal, explains Evans.
For a diagnosis, these symptoms would need to be present for most of the day, nearly every day, over a minimum period of two weeks.
"Anxiety can also result in disturbances in sleep, thinking and memory as with depression, and the two are often experienced together. Feeling restless, agitated, tense, worried or panicky are typical symptoms of anxiety," she said.
Perinatal mental distress can affect any woman, rich or poor, educated or not, employed or unemployed, in any pregnancy, but the prevalence is much higher in a developing (LMIC - low-middle income) country like ours. This is due to high levels of poverty, and other stressors like HIV/Aids, unemployment and violence," said Evans.
She said there are also certain personal factors which may put women at risk of developing mental illnesses around the time of having a baby, such as having lost a previous pregnancy or a child after birth, intimate partner violence, previous or current abuse of any kind, having had depression and/or anxiety in the past, recent major life events, poverty and food insecurity, not having a good relationship with her mother or her mother having died, among others.
"Anxiety and depression, if not too severe, can be effectively treated with counselling by trained counsellors or mental health professionals and can improve dramatically with adequate family and social support.
"When care providers respond in an empathic way, with attention and care, it helps enormously.
"When ongoing distress is more severe, medication prescribed by a doctor or psychiatrist may be needed in addition to counselling or psychotherapy. "Getting support from a group, like a moms and babies' group can also help greatly."
Some of the extreme or complicated cases encountered at the project over the years have included clients with complicated lives due to lack of support or dysfunctional relationships with family and partners, debilitating mental illnesses, substance abuse problems and suicidal behaviour.
"The baby may be affected by the mother's emotional state as well as the emotional well-being of others in the home. Also, if a mother is using alcohol or substances (often in an attempt to self-medicate to help cope with feelings) during pregnancy, this can damage the development of the foetus and child.
"It may be more difficult for a depressed mother to visit the antenatal clinic for check-ups, or take her HIV/Aids medication or other medications that may affect her and her baby's health."
Perinatal mental distress can affect any woman, rich or poor, educated or not, employed or not, in any pregnancy
For more information on the Perinatal Mental Health Project:
Do you suspect that you have perinatal mental illness?
* Talk to someone that you trust. This could be your healthcare provider at the antenatal or postnatal clinic, your GP, social worker, religious leader, friend or family member.
NGOs that offer professional help:
* Lifeline counselling services: share call number: 0861 322 322
* Mosaic Centre for Women & Children: 021 761 7585
* The Parent Centre: 021 762 0116
* Famsa: 021 447 0170, 082 231 4470
* Cape Mental Health: 021 447 9040
* South African Depression and Anxiety Group: 0800 21 22 23.