Maternal Mental Health & Child Health and Development
Maternal mental health problems pose a huge human, social and economic burden to women, their infants, their families, and society and constitute a major public health challenge. Although the overall prevalence of mental disorders is similar in men and women, women’s mental health requires special considerations in view of women’s greater likelihood of suffering from depression and anxiety disorders and the impact of mental health problems on childbearing and childrearing, too.
- Depression and anxiety are approximately twice as prevalent globally in women as in men, and are at their highest rates in the lifecycle during the childbearing years, from puberty to menopause.
- Studies of depression and anxiety show their incidence to be approximately 5% in non-pregnant women, approximately 8-10% during pregnancy and highest (13%) in the year following delivery.
- Suicide is one of the most common causes of maternal death in the year following delivery in developed countries.
- Psychosis, by contrast, is relatively rare and occurs in only 1 to 2 women for every 1000 giving birth. The rates of psychosis following delivery may be higher in less developed countries, where infection may contribute to its occurrence.
Who is at risk of these disorders?
Virtually all women can develop mental disorders during pregnancy and in the first year after delivery, but poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), emergency and conflict situations, natural disasters, and low social support generally increase risks for specific disorders.
Consequences of maternal mental disorders during pregnancy
During pregnancy the affected woman is less likely to eat and sleep well and may fail to adequately gain weight. She is less likely to attend prenatal care and may even fail to seek help for the birth. She is more likely to use harmful substances such as alcohol, cigarettes and drugs and may attempt to injure or kill herself.
Stress hormones are raised during maternal mental illness and may have also has physical effects on the mother (predisposing her to maternal high blood pressure, pre-eclampsia, early and difficult delivery) and on the developing babies, who may be and small for age infants.
Effects of maternal mental disorders after birth on the mother, infant and family
After the birth, the depressed mother may fail to adequately eat, bathe or care for herself in other ways. This may increase the risks of infection and anaemia. The risk of suicide is also a consideration, and in psychotic illnesses, the risk of infanticide must also be considered.
Very young infants can be affected by and are highly sensitive to the environment (largely represented by the mother) and the quality of care, and are likely to be affected by mothers with mental disorders – especially if the mother has low mood, social withdrawal, irritability, impaired thinking and feelings of hopelessness.
Prolonged or severe mental illness hampers the mother-infant attachment, breastfeeding and infant care. Depressed and anxious mothers are less likely to look at their infants’ faces and emotionally connect with them, and they are also less likely to understand cues of hunger, happiness or distress and therefore are less responsive to the baby.
- Infants of chronically depressed mothers show less sociability with strangers, fewer facial expressions, smile less, cry more, and are more irritable than infants of normal mothers.
- Children of chronically depressed mothers do not perform as well on thinking and intelligence tests at 18 months of age and this is especially true for boy babies’ speech development.
- Children of depressed mothers are also more distractible, less playful and less social up to age 5.
The effects of maternal mental disorder in older children in the family may include neglect, abuse and slower social, emotional and cognitive development, including higher rates of school and behaviour problems.
Maternal mental illness may have serious effects also on the marital relationships, especially in the case of prolonged or serious mental disorder. These may include disruption of the marriage and/or spousal abuse by either partner.
What to do?
Although in many settings different levels of mental health care continues to be provided in isolation from general health care, we know now that it can be integrated into general health care; this is also valid for maternal mental health care.
The most common preventive strategy has been to modify risk factors for maternal mental disorders. Numerous studies have evaluated preventive interventions including social support, as well as educational, psychological and pharmacologic models of care; other interventions, such as exercise, massage, herbs and rituals have also been used.
2. Identification of maternal mental disorders:
Simple questions asked during pregnancy and in the postpartum period may help to identify women at greater risk for mental disorders, for instance:
- Depression: “How much of the time during the last month have you felt down hearted and blue?”;
- Anxiety: “How much of the time during the last month have you been a very nervous person?”;
- Psychosis: “Have you been receiving any special messages from people or from the way things are arranged around you?"
3. Management and Care
- The hopeful message is that 70-80% of women with maternal mental disorders can be successfully treated and recover! This is good news for the woman, her infant and her family! The woman and her partner, if appropriate, should be involved in education about maternal mental disorders, treatment and decision-making.
- Another positive message is that to a large extent the identification and management of most of these mental disorders can be done at primary health care level, by first line interveners, incorporated into primary health care routines.
The Way Ahead
Women who self-identify as distressed, or who are identified through healthcare workers, family, friends, or screening, as possibly suffering from a maternal mental disorder need a timely contact with trained first-level care providers. The healthcare system must also facilitate the referral of these women to trained mental health professionals, whenever needed.
Education about maternal mental health should be part of all health disciplines’ training, including in-service training. National or state governments need to make these issues a priority for education and provision of adequate services through financial resources targeted towards pregnant and postpartum women with mental disorders, and their infants and children.