Doctor says more needs to be done to detect maternal mental illness in SA
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DURBAN - Maternal mental health is a grossly undetected and under-managed issue in South Africa, according to Durban family medicine registrar Dr Adam Asghar.
With the month of May being set aside to shine the spotlight on Maternal Mental Health awareness, Dr Asghar, who worked on maternal and perinatal care at Bethesda Hospital in KZN, spoke about the issues affecting mothers post-delivery.
Asghar said from his understanding, over one-third of pregnant women in KZN experience some sort of mental illness from depression or anxiety to psychosis which is more rare.
He said while psychosis, where someone has a disconnection with reality and is hearing voices or seeing things, is relatively easy to pick up, anxiety and depression is more hidden.
“I strongly suspect that the burden of depression and anxiety is not being dealt with because those are kind of hidden mental illness and not quite as overt.”
In rural KZN, where Asghar previously worked, he said there were lots of risk factors for maternal mental illness.
These include poverty, gender-based violence, HIV, unplanned pregnancy, teen pregnancy and not having a supportive partner or friends.
He said the postpartum period – which is six weeks post-delivery in SA, is stressful enough – especially for first-time mothers – without adding all of these additional factors.
Asghar said recognising the signs of mental issues such as anxiety and depression is tricky and that it was best for an affected person to recognise whether or not they were not functioning as their normal self.
“You can go to a healthcare provider and say, ‘I’m feeling this’, whether is psychological or physical but the healthcare provider is not the one who knows how that particular feeling is affecting you.”
He said with both anxiety and depression the time period over which a person experiences these emotions was key.
With depression, Asghar said symptoms include feelings of excessive sadness, not sleeping or sleeping too much, not eating, eating too little or eating too much and withdrawing from friends and family.
“If that continues for more than a month then you need to start thinking about depression.”
With regard to anxiety, there would be heightened awareness, panic attacks, feeling uncertain or scared about the future, he said.
“It becomes a mental illness if it's there for a significant period of time and it has a significant impact on how the woman functions.”
Asghar said historically and to date, SA has not been good at picking up the more common mental disorders because they are so subtle.
“There’s a lot of stigma associated with mental illness and people just soldier on I guess.”
Most people’s port of entry for assistance to get help in the public sector would be community clinics unless there is an emergency, said Asghar.
“In the context of mental illness and there is a threat to someone’s life whether it’s through suicide or someone is being dangerous towards other people then the hospital is the best place to go.”
Asghar further explained that these mental illnesses should not be confused with the baby blues
“There’s this concept known as the baby blues where a woman can feel excessively sad for a period of time after delivery. That’s not a mental illness, that’s just part of the spectrum of normal so to speak.”
He said the country’s current health system is not effective at picking up maternal mental illness.
“We do have some screening tools in place like when a pregnant woman starts antenatal care. There are screening questions about psychosocial risk factors and there’s a brief mental health screen that’s supposed to be done but we are still on the back foot when it comes to mental illness.”