Mothers’ mental health impacts their children, experts say

(CNN)– Postpartum depression (PPD) is estimated to affect more than one in ten women having a baby and is just one of many mood disorders a woman may experience during pregnancy or during pregnancy. first year after childbirth, known as the perinatal period.

Yet these conditions, known as perinatal mood disorders, remain largely misunderstood by the public and medical professionals, experts said at a panel discussion hosted by the Gender Reporting Team. CNN’s As Equals. .

Following CNN’s reporting on the tragic experience of a family with postpartum depression, which had a huge impact on the public, As Equals brought together an international group of people with experience and expertise in maternal mental health to discuss the true prevalence of postpartum depression of these disorders, their underlying causes, problems with diagnosis and treatment, and finally, possible solutions.

A “lack of appreciation” for mental health in motherhood

The conversation started with the confirmation of the panelists that the number of mujeres affected by trastornos del estado de perinatal animator is probably much more than one of cada 10, y coincidieron de form unanime en que el tema sigue siendo descuidado por los servicios sanitarios de everybody.

“There is still a widespread perception that mental health is a luxury,” said Simone Honikman, founder and director of the Perinatal Mental Health Project in Cape Town, South Africa.

She explained that a woman’s mental health affects not only her physical health, but also that of her baby, directly or indirectly, because when she has a mental health problem, she may not seek other health services. crucial to her health or to the well-being of her child.

“There is little appreciation that these mental health issues have a direct impact on physical health conditions and are strongly correlated with a range of physical health considerations, whether it is the use of services, health-seeking behavior, premature birth, low birth weight, stunted babies, use of assisted antiretroviral therapy or other forms of treatment,” Honikman said.

An international panel of experts discussed the gaps in mental health services around the world during a panel discussion hosted by CNN As Equals.

Kazione Kulisewa, a consultant psychiatrist at Kamuzu University of Health Sciences in Malawi, agreed that mental health takes a back seat to other physical conditions, but explained that in countries like Malawi, where there are Multiple competing health priorities and very limited resources make it even more difficult to lobby for investment in maternal mental health care when rates of HIV and maternal mortality are so high. (In Malawi, an estimated 10% of women aged 15-49 were living with HIV in 2020, and the southern African country has one of the highest maternal mortality rates in the world, with 439 maternal deaths per 100,000 live births (in the United States, this figure is 23.8 per 100,000).

Despite these challenges, Kulisewa was adamant: “Mental health issues, when left untreated, cause a greater burden than some of the infectious diseases,” he said.

The repercussions of this neglect of perinatal mood disorders are enormous. A World Health Organization (WHO) study found that women with postpartum depression were twice as likely to suffer from depression four years later and were significantly more likely to have a chronic condition. Studies have also shown the relationship between the mental health of mothers and the health of their children.

We do not prepare women

For Jen Schwartz, CEO of Motherhood Understood, a US-based organization that connects and educates women about perinatal mental illness, the biggest concern is stigma and lack of awareness.

Schwartz herself suffered from severe postpartum depression and anxiety following the birth of her son nine years ago and recalls feeling uninformed, isolated and ashamed. She believes that by not educating and supporting women more openly about mental health issues during pregnancy and motherhood, “we are not preparing women to know what to look for and to know that something is wrong. not”.

“I think the ramifications of that are huge,” Schwartz said, explaining that the resulting isolation makes women unable to talk about how they feel. “You don’t talk and you suffer in silence,” he said.

Lack of knowledgeable professionals at all levels

Experts also recognized the lack of professionals working in the sector, such as psychologists and perinatal therapists specializing in maternal mental health, but also midwives and antenatal care providers with knowledge in this area, so that they know what symptoms to look for. As an example, Kulisewa pointed out that there are only three perinatal psychiatrists in Malawi, which has a population of 19 million. CNN was unable to contact Malawi’s Ministry of Health to confirm this.

However, panel members also unanimously agreed that community organizations are also crucial.

Dr Prabha Chandra’s team from the National Institute of Mental Health and Neuroscience in India worked with women and communities in Karnatika State to test various interventions with mothers, as well as discuss with husbands and mothers-in-law about depression and anxiety. like, as these relationships play an important role in the well-being of new mothers in India.

Chandra stressed the need to find culturally appropriate ways to raise awareness of maternal mental health, such as simplified diagnostic methods and locally produced films and materials that take into account local sensitivities and communicate in a way that people can understand. .

The need for systemic change

Having established the many challenges: limited resources, lack of trained personnel, consistent data collection around the world, competing public health needs, persistent stigma and shame, inadequate understanding of the scale and impact of the problem both among legislators than in the general public, the debate has turned to solutions, and those that could bring about systemic change.

A critical part of the solution is to better integrate maternal mental health services into a country’s existing health infrastructure, such as antenatal services or child development programs. Many panelists said this integration is essential so that funding or support for maternal mental health services is not dependent on political support and can survive changes in leadership, which around the world are driving changes in public health priorities. .

This integration has been achieved in many high-income countries, said Jane Fisher, professor of global health at Monash University. “There is public recognition, but substantial investments were needed in public education, health care, job training and the creation of multi-level services,” he said.

But it will take some time before this is realized in low- and middle-income countries.

Another important solution that was proposed was the need to adapt the standard tool used around the world to detect mental health problems in the perinatal period, the Edinburgh Postnatal Depression Scale, created over 30 years ago. The WHO says the scale should be used as a starting point and not a diagnostic tool, and panel experts agreed, but said a one-size-fits-all test like this doesn’t work well in practice. .

“There is a strong need for tools to be developed from the specific context of each country, using local idioms,” Honikman explained. She described the Edinburgh Scale as too long and complicated to be used by busy midwives caring for thousands of women, and felt the language used was inappropriate for the communities her team worked with. So they created their own detection tool, shorter and in three local languages.

Looking at other solutions, others spoke of the need to increase mental health awareness and knowledge among the public, politicians and health professionals to have real impact, and finally more funding and financial support.

Missed opportunities for prevention

A final point raised by Chandra and others was the possibility of prevention. If health systems address risk factors for maternal mental illness early, the onset of the disorder can be prevented. These risk factors include poverty, domestic violence and childhood trauma, and are likely to be higher in countries that rank lower on the gender equality index, such as India, Chandra explained.

It is estimated that women who experience domestic violence during pregnancy are three times more likely to develop postpartum depression, and studies show that the disorder is two to four times more likely in women living in poverty.

“If domestic violence is reduced […] and poverty in families is reduced, much more can be done in terms of reducing mental health problems than a million psychiatrists will ever achieve,” said Alain Grégoire, co-founder of the World Alliance for maternal mental health.

For an hour and a half, the various experts spoke passionately about the needs of new mothers and expressed their frustration that more is not being done for maternal mental health, given what is known about their prevalence and the necessary measures, often simple, to reduce this.

In conclusion, Schwartz reiterated a link that had been made earlier in the discussion; simply pointing to leaders who care about the well-being of the children, but who perhaps see the well-being of the mother as a lesser priority: “Caring for the mother and taking care of her mental health [es] the best way to take care of your baby.

If you or someone you know may be at risk for a perinatal mood disorder, here are ways to help.

If you are in the United States, you can call the ISP helpline at 1-800-944-4773 or text “Help” to 800-944-4773. To find support in other countries, see the list of providers here. To join an online support group, click here.

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