Charlotte Kenyon, Senior Lecturer and Midwife, University of Huddersfield will be leading this week’s ENB twitter chat on Wednesday the 7th of January between 8-9pm focusing on ‘perinatal mental health disorders’. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.
Shortly before Christmas, across the United Kingdom the tragic story of the death of Charlotte Bevan and her daughter Zaani unfolded. Sadly, her story is not unique. Pregnancy and birth are usually one of the happiest occasions in a woman’s life, but for many this is not the case. Perinatal mental ill health represents an area of high human cost, through both maternal morbidity and mortality and the impact on the long-term health and wellbeing of children. There is a recognised deterioration of mental health among women in general with increasing numbers of non-pregnant women experiencing depression, anxiety and even suicidal thoughts. However, despite an increasing public awareness of mental health in pregnancy, three quarters of women featured in the most recent confidential enquiry into maternal death had some form of pre-existing mental illness.
Perinatal mental health disorders are classified according to the severity of symptoms and may range from transient emotional disorders such as postnatal ‘blues’ through to more serious experiences of stress, anxiety and depression. Depression during and after pregnancy may range from mild to moderate, for which primary care will normally be the most appropriate course of action, through to severe postnatal depression for which specialised and sometimes in-patient treatment may be required (DH 2003). Postnatal depression (PND) is just one element of perinatal mental health, classified as DSM-IV; it is a major depressive disorder within one month of birth and affects between 10 and 20% of pregnant women. Depressive symptoms frequently start during pregnancy (Gavin et al 2005, Stowe et al 2005, Freeman 2009). A small number of women will go on to develop severe prolonged psychotic illness, puerperal psychosis.
There are a number of recognised risk factors which include a known history of depression, reduction in income and a perceived loss of control. Marital difficulties, the absence of a supportive partner, loss of income and loss of supportive networks associated with absence from work are also known contributory factors (Johansen et al 2000, Bowen and Muhajorin 2006, Hanley 2009), as are a history of sexual or physical abuse and domestic violence (National Mental Health Development Unit (NMHDDU) 2010). There is an increasing body of opinion that suggests that stress and anxiety relating to pregnancy itself play a significant role in the development of mental ill health in pregnancy.
Of the women who access mental health services in pregnancy antenatal depression affects between 6.5 and 50 per cent of all pregnant women (Bennett et al 2004, Gavin et al 2005, De Tychey et al 2005, Stowe et al 2005, Bowen and Muhajorin, 2006). Given the prevalence of antenatal depression, some suggest that routine screening of all women should be implemented (Bowen and Muhajorin, 2006). NICE guidelines have made recommendations about mental health in pregnancy since 2007 (NICE 2007), but how has this benefitted Charlotte Bevan and others like her.
Question for consideration:
Do we have good examples of services, able to provide for women experiencing mental health difficulties in pregnancy, or does the system not care?
References and further reading:
Bennett, H., Einarson, A., Taddio, A., Koren, G., and Einarson, T., (2004) Prevelance of depression during pregnancy:systematic review Obstetrics and Gynaecology, 103, 698-709.
Bowen, A., Muhajorine, N., (2006) Antenatal depression: nurses who understand the prevalence, signs and symptoms, and risk factors associated with antenatal depression (AD) can play a valuable role in identifying AD and preventing the sequelae in pregnant women and their families, Canadian Nurse, 2006 Nov; 102(9): 27-30.
De Tychy C., Spitz E., Briancon S., et al (2005) Prenatal depression and coping: a comparative approach. Journal of Affective Disorders 85, 323-326.
Department of Health (2003) Mainstreaming gender and women’s health: implementation guide DH, London.
Freeman MP (2009) Complementary and Alternative medicine for perinatal depression Journal of Affective Disorders 112, 1-10.
Gavin, N., Gaynes, B., Lohr, K., Meltzer-Brody, S., Gartlehner, G., and Swinson, T., (2005) Perinatal depression: A systematic review of prevelance and incidence, Obstetrics and Gynaecology 106, 1071-1083.
Hanley J., (2009) Perinatal mental health: a guide for health professionals and users, Wiley-Blackwell.
Johanson R., Chapman G., Murray D., et al (2000) The North Staffordshire Maternity Hospital prospective study of pregnancy associatd depression, Journal of Psychosomatic Obstetrics and Gynaecology 2000, 21(2) 93-97.
National Mental Health Development Unit (NMHDU) (2010) Working towards Women’s Wellbeing: Unfinished Business NMHDU, London.
NICE (2007) National Institute of Clinical Excellence Clinical Guidelines on Antenatal and Postnatal Mental Health NICE, London.