perinatal mental health research
The National Perinatal Association has partnered with Mental Health America to bring you their useful, quick, and easy screening tools.. Répondez à notre #Sondage pour un changement si vous êtes prestataire de soin. Supporting parenting. The safety of antipsychotics has been less well studied, but evidence may be prone to even greater confounding by indication and comorbidity. However, as staff in generic services need to address the needs of women of childbearing age, there is a potential risk of such perinatal mental health services deskilling staff in community and generic care. If not us, who? Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We combine relational knowledge with relational care by providing trainings that offer an integration of perinatal mental health research, clinical experience, and personal wisdom. The Edinburgh Postnatal Depression Scale137, the most commonly used scale in perinatal RCTs, has been translated into more than thirty languages and has reasonable diagnostic accuracy. A meta‐synthesis of 20 studies of the experiences of fathers reported that services tend to focus on individual women (and babies), with a marginalization and neglect of women's partners and an unmet need for information by these partners168. Barriers to accessing services may occur at multiple points in the care pathway. These will vary depending on the context, but could include policies involving the criminal justice system (particularly in relation to domestic violence or trafficking), minimum alcohol pricing to reduce foetal alcohol syndrome and family violence, smoking bans, and welfare benefits. In LMICs, there may be additional cultural barriers and stigma181, 182. SSRIs and other antidepressants may be associated with a small risk of prematurity, especially when used in the 2nd and 3rd trimesters123-125, though this could reflect residual confounding by indication. 2011 May;24(3):208-14. doi: 10.1097/YCO.0b013e3283459422. This figure doesn't include trauma occurring in the effort to become pregnant, during the course of pregnancy, perinatal loss, or complications in the newborn period itself. Antenatal anxiety is associated with a small increase in emotional problems in early and middle childhood. The specific circumstances of pregnancy, birth and early mother/infant bonding requires staff who are knowledgeable, In this paper, we summarize and critically examine the epidemiology of mental disorders in relation to childbirth and their impact on the foetus/infant/child, and then focus on the evidence base for interventions during pregnancy and postpartum, as well as in the preconception period, at the individual and population level. In general, the risks are greater among women in LMICs than HICs, among those with chronic severe mental illness, and among those with important concomitant conditions such as smoking, substance misuse, poverty and domestic vio‐lence. Qualitative studies suggest that receiving interventions within generic services can be experienced as unhelpful by women189, 195, partly due to the therapists' failure to understand the potential impact of mental disorders on maternal functioning195, and poor facilities for infants169, 195, though, as RCTs in LMICs demonstrate, task‐shifting is possible if staff are suitably trained96. Insecure or disorganized attachment is associated with externalizing (and, to a lesser extent, internalizing) childhood prob‐lems74, 75. There is a risk of “blaming” mothers for the health of future generations165, when the need for family and system level interventions is clear. Other physical treatments, such as trans‐cranial magnetic stimulation, have limited clinical indications131, may not have sustained benefits beyond a few weeks post‐treatment, and have limited pregnancy safety data132, so that further research is warranted. As with other research136, there is limited use of clinically significant patient‐defined outcome measures. This review highlighted the lack of controlled studies for mental disorders other than depression. Where specialist community perinatal mental health services are available, the optimal skill mix of such services is not yet known. Objective Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. A systematic review of 29 trials (2,779 patients)86, predominantly of depression (28 trials), reported a moderate treatment effect of CBT (seven trials) and to a lesser extent IPT (four trials). In addition, some perinatal interventions target depression, anxiety and/or trauma symptoms and other risk factors for adverse child outcomes, such as substance misuse, smoking and unsafe infant care practices, with promising results95. The Antenatal and Postnatal Mental Health Guidelines produced by the NICE2 recommended comprehensive psychosocial assessment by mental health services within two weeks, and treatment within six weeks. Many research studies have … Perinatal mental health then, refers to any issues that cause complications for the mum during this time. To our knowledge, little research directly examined this issue. This could be due to increase in primary care attendance (due to greater awareness of mental health problems) and/or increased detection, and/or different populations. Research into the psychometric properties of quality of life measures finds that the Short‐Form Six‐Dimension (SF‐6D) may better capture the effectiveness of perinatal interventions than the more frequently used EuroQol‐5D‐5L (EQ‐5D‐5L)140, though replication is needed to inform future studies of cost‐effectiveness. This ambitious research and service development agenda requires an urgent scaling up of research and clinical capacity on the continent, as set out in the World Psychiatry Association's position statement on perinatal mental health. The evidence base on psychotropic use in pregnancy is almost exclusively observational. Perinatal mental disorders are common – indeed, the commonest complication of child‐bearing – and are associated with considerable maternal and foetal/infant morbidity and mortality5-7. For other psychotropics, the evidence suggests less significant harm, but is more challenging to interpret. Caution regarding the use of this new medication has been suggested on scientific, clinical and cost‐effectiveness grounds135, including concerns that findings reflect statistically significant but not clinically meaningful differences. Women often have themselves a history of developmental trauma, including removal from their own parents who may have been violent and abusive, and other experiences of childhood maltreatment192. By contrast, there is an extensive literature on potential risks of antidepressants, mood stabilizers and antipsychotics. Since then, additional funds have been promised, with the aim of ensuring that women in all parts of the UK have access to specialist community services and psychiatric inpatient mother and baby units, and extending service provision up to two years postpartum. Working with mothers and their infants to improve their interaction and attachment is important in preventing mental health problems from developing in children. A study using a large English pregnancy cohort found that exposure to each additional risk factor increased the odds for an internalizing and externalizing disorder76, underlining the need for multidisciplinary treatment approaches. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. In general, there is no evidence that antipsychotics are major teratogens, but their use may be associated with greater metabolic risks for the mother and growth impairment in infants (including risk of being large for gestational age among babies exposed to second‐generation anti‐psychotics)55. Some uncertainties remain regarding effect sizes, but there is consistent evidence of improvement in depressive symptomatology. Other studies also highlight the importance of personality disorder with respect to adverse outcomes such as higher levels of dysregulated infant behaviour69. Does Resolution 8430 of 1993 respond to the current needs of ethics in health research with human beings in Colombia? Accessibility Maternal schizophrenia and pregnancy outcome: does the use of antipsychotics make a difference? 2018a, 2018b), as well as a widespread absence of clear mental health care pathways for women in the maternity system (Higgins et al. This is also the case for perinatal mental disorders. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. Development of the 10‐item Edinburgh Postnatal Depression Scale, Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individ‐ual patient data meta‐analyses, Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low‐and lower‐middle‐income countries: a systematic review, Psychometric properties of the five‐level EuroQoL‐5 dimension and Short Form‐6 dimension measures of health‐related quality of life in a population of pregnant women with depression, Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial, An integrated intervention to reduce intimate partner violence in pregnancy: a ran‐domized trial, Antenatal domestic violence, maternal mental health and subsequent child behaviour: a cohort study, Remissions in maternal depression and child psychopathology: a STAR*D‐child report, Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: a randomised controlled trial, Effective treatment of postnatal depression is associated with normal child development, Maternal mental health and infant emotional reactivity: a 20‐year two‐cohort study of preconception and perinatal exposures, Impact of dysfunctional maternal personality traits on risk of offspring depression, anxiety and self‐harm at age 18 years: a population‐based longitudinal study, The Victorian Intergenerational Health Cohort Study (VIHCS): study design of a preconception cohort from parent adolescence to offspring childhood, Preconception care: maximizing the gains for maternal and child health, Women with bipolar disorder and pregnancy: factors influencing their decision‐making, Thoughts and considerations of women with bipolar disorder about family planning and pregnancy: a qualitative study, “What if I get ill?” Perinatal concerns and preparations in primi‐and multiparous women with bipolar disorder, Decisions about the use of psychotropic medication during pregnancy: a qualitative study, Pre‐conception to parenting: a systematic review and meta‐synthesis of the qualitative literature on motherhood for women with severe mental illness, Responses to warnings about the impact of eating disorders on fertility: a qualitative study, Preconception care in mental health services: planning for a better future. improved measurement (adapting use of current instruments and/or developing new instruments, where needed, for the perinatal period, with robust eval‐uation of their psychometric proper‐ties); development of one or more core outcome sets, with the participation of women with lived experience of disorders; development of methods so that outcomes related to infant physical and mental health can be included in cost‐effectiveness analyses of interventions for perinatal mental disorders, more systematic use of tools when designing and evaluating studies in systematic reviews (e.g., ROBINS‐I. Interventions include psychological therapies, medications, support in the relationship with the infant, and care planning including for women with a history of moderate to severe illnesses who may relapse in the postnatal period. Nevertheless, it has been estimated that, for each woman requiring psychiatric admission following birth, 2.5 require outpatient treatment and 12 receive pharmacological treatment in primary care11. Perinatal mental health . K23 MH085007/MH/NIMH NIH HHS/United States, K23 MH085007-01A1/MH/NIMH NIH HHS/United States, K23MH085007-02/MH/NIMH NIH HHS/United States, UL1RR024982-03/RR/NCRR NIH HHS/United States, UL1 RR024982/RR/NCRR NIH HHS/United States. 10; 20; 50; 100 ; Sort by: Publication date. If a key aim of perinatal mental health services is to minimize intergenerational psychopathology, then a family‐focused, rather than a mother‐focused individual approach, is likely to better meet this aim36. A qualitative meta‐synthesis, Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England, Perinatal depression care pathway for obstetric settings. Nevertheless, the research on racial and ethnic disparities in perinatal mental health (and mental health in general) is lacking, and the majority of research in this area focuses on postpartum depression. About our maternity and perinatal mental health research UK enquiries into maternal and perinatal deaths (during pregnancy or during the first year after the birth of a child) have consistently found that women and babies from the poorest backgrounds; women from black, Asian and minority ethnic (BAME) groups; and women with mental illness, are at greatest risk of severe morbidity and mortality. Research by St John of God Raphael Services further supplements our work in perinatal mental health research. Beyond Blue's perinatal health professional activities have transitioned to the Centre of Perinatal Excellence (COPE), with the October 2017 release of the revised clinical guidelines Effective mental health care in the perinatal period: Australian Clinical Practice Guidelines. The extent of improvement is, however, adversely impacted by key clinical and demographic factors, such as a diagnosis of schizophrenia or personality disorder, low social support and low socio‐economic status206. Evidence of safety is dependent on long‐term outcomes, which are rarely collected. We also recently reported a population prevalence estimate of common mental disorders of 45.1% (95% CI: 23.5‐68.7) in pregnant women less than 25 years of age, compared with 15.5% (95% CI: 12.0‐19.8) in women aged 25 years of more (adjusted odds ratio: 5.8, 95% CI: 1.8‐18.6)30. SSRIs have been linked to an increased risk of a severe respiratory neonatal con‐dition (persistent pulmonary hypertension of the unborn), but with a small ab‐solute risk of around 3 in 1,000 reported in a recent systematic review126. An international position paper on mother-infant (perinatal) mental health, with guidelines for clinical practice. Privacy, Help 2018a) and a lack of referral options (Noonan et al. 2007 Sep 19;8:10. doi: 10.1186/1472-6939-8-10. There have been no trials, to our knowl‐edge, that have examined whether preconception mental health interventions improve distal maternal and infant outcomes, but there is a growing literature on what women with mental disorders would like from preconception care. Featured Patricia Tomasi. This site needs JavaScript to work properly. While the focus of this review is on treatment rather than prevention of perinatal mental disorders, we agree with recent arguments in this journal164 that current prevention programmes for depression do not target the strongest determinants of risk and are not structurally embedded in major social systems. There is an emerging literature reporting an association between preconception mental health and perinatal depression18, mother‐infant bonding50, and infant and child outcomes150-152.