PERINATAL                   AND                   MATERNAL                   MENTAL                   HEALTH:             ...
Overview   What is Mental Health?   Mental health problems during pregnancy and    new motherhood   Effects of mental h...
Overview   What is Mental health?   Mental health issues during pregnancy and    new motherhood   Effects of mental hea...
What is mental health?   World Health Organization     “Health is a state of complete physical, mental      and social w...
What is mental illness?   Can include:     Emotional    distress     Sense of hopelessness or despair     Anxiety and ...
Mental Health/PsychosocialParadigms   Some use them interchangeably   Others differentiate     Mentalhealth – clinical ...
Overview   What is mental health?   Mental health issues during pregnancy and    new motherhood   Effects of mental hea...
Terms and Timeframes   Perinatal period: Pregnancy and the 12    months following childbirth  (Gavin et al., 2005)     A...
Mental Health Issues - Distress   Fears   sleeplessness   Too many thoughts   Concerns about the future   Confusion  ...
Mental Health Issues -Disorders   Depression       Major Depressive Disorder       Dysthymia   Anxiety       Generali...
Overview   What is mental health?   Mental health issues during pregnancy and    new motherhood   Effects of mental hea...
Effects of maternal mental health    problems on the women and    children   Maternal health     Strong   link between m...
Effects of maternal mental health    problems on the family   Relates to functioning – as a member of the    family, as a...
Overview   What is mental health?   Mental health issues during pregnancy and    new motherhood   Effects of mental hea...
Risk factors   Prior history of disorder   Trauma – including gender-based violence   Pregnancy/birth complications/mis...
HIV-infection   HIV and mental health     Elevated rates of mental health problems among HIV-      infected people     ...
Trauma   Trauma exposure     Prevalent   in low-resource countries     Causes: war, economics, gender-issues     Relat...
Overview   What is mental health?   Mental health issues during pregnancy and    new motherhood   Effects of mental hea...
Prevention   Often lack of specialized services   Where services exist, generally inadequate to    meet population needs...
Treatment   Psychosocial programming     Social support groups     Social/economic resources   Psychological services ...
Example of an InnovativePrevention Program   Caregiver training program to improve    neurocognitive development in at ri...
Example of an InnovativeTreatment Program   Cognitive Processing Therapy (CPT) to treat    severe distress among survivor...
Conclusion   Problems are real – range from distress to    disorder   Impact full range of the woman‟s life:    self, ch...
Acknowledgements   Collaborators within the Applied Mental Health    Research Group (AMHR)     Paul   Bolton, MBBS; Laur...
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Maternal Mental Health_Bass_5.4.12

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  • TheWHO describes health asa state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” When we’re speaking about mental health, then, it’s not just a matter of whether or not someone is experiencing something that is diagnostically defined as “mental illness.” We’re talking about a state of contentment, functionality, and productivity. An ability to recognize the value and abilities of oneself, and to take on the necessary responsibilities of life.
  • There are lots of overlap in these terms, but in essence what we’re talking about is the experience of pregnancy – from the beginning through birth – and the period following, in which a woman adjusts to new motherhood
  • Maternal Mental Health_Bass_5.4.12

    1. 1. PERINATAL AND MATERNAL MENTAL HEALTH: INTERNATION AL ISSUESJudith Bass, PhD, MPH Department of MentalHealthJohns Hopkins Bloomberg School of Public Health
    2. 2. Overview What is Mental Health? Mental health problems during pregnancy and new motherhood Effects of mental health problems on women, children, and families Risk factors Prevention and treatment
    3. 3. Overview What is Mental health? Mental health issues during pregnancy and new motherhood Effects of mental health on women, children, and families Risk factors Prevention and treatment
    4. 4. What is mental health? World Health Organization  “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Not simply the lack of mental illness  Complete and general state of well- being, functionality and productivity  Ability to contribute to self, family and community
    5. 5. What is mental illness? Can include:  Emotional distress  Sense of hopelessness or despair  Anxiety and restlessness  Inability to perform basic tasks Symptoms can be both physical and emotional
    6. 6. Mental Health/PsychosocialParadigms Some use them interchangeably Others differentiate  Mentalhealth – clinical illness/clinical care  Psychosocial – distress/support services Alternative option  Continuum of needs and issues  Varying over time and across populations  Selection based on population needs and resource availability
    7. 7. Overview What is mental health? Mental health issues during pregnancy and new motherhood Effects of mental health on women, children, and families Risk factors Prevention and treatment
    8. 8. Terms and Timeframes Perinatal period: Pregnancy and the 12 months following childbirth (Gavin et al., 2005)  Antenatal period: Pregnancy  Postpartum period: Definitions have ranged from a few days up to twelve months following childbirth MCH period: Services through child age 5
    9. 9. Mental Health Issues - Distress Fears sleeplessness Too many thoughts Concerns about the future Confusion  Unexpected body changes and experiences for women having first child Social pressures  Changes in role – whether its first/multiple  Additional burden – economic, social Shame (if unwanted) Isolating in some cultures
    10. 10. Mental Health Issues -Disorders Depression  Major Depressive Disorder  Dysthymia Anxiety  Generalized Anxiety Disorder  Specific Phobias Post-traumatic Stress Severe Illness - psychoses  Schizophrenia  Bipolar Disorder Substance use disorders  Alcohol  Drugs
    11. 11. Overview What is mental health? Mental health issues during pregnancy and new motherhood Effects of mental health issues on mothers, children, and families Risk factors Prevention and treatment
    12. 12. Effects of maternal mental health problems on the women and children Maternal health  Strong link between mental health and chronic illness  For HIV-infected women, depression linked to adherence Child health and development  Increased rates of infant malnutrition, illness and growth problems  Early childhood a sensitive period for neurocognitive development – need attentive, available mother  Attachment in childhood relevant throughout the life-course
    13. 13. Effects of maternal mental health problems on the family Relates to functioning – as a member of the family, as a member of the community During pregnancy  Change in capacity – especially if complications Motherhood  Husband/other children need attention  Responsibilities to home/community  Mental health problems can be stigmatizing/isolating to the individual and the family
    14. 14. Overview What is mental health? Mental health issues during pregnancy and new motherhood Effects of mental health issues on mothers, children, and families Risk factors Prevention and treatment
    15. 15. Risk factors Prior history of disorder Trauma – including gender-based violence Pregnancy/birth complications/miscarriage STDs and HIV Age Parity (primi/multi) Social status Gender preferences Substance abuse
    16. 16. HIV-infection HIV and mental health  Elevated rates of mental health problems among HIV- infected people  Particularly Depression and Anxiety problems  Depression linked to reduced treatment adherence Risk factors that are related to both HIV infection and to mental health problems  Example: poverty and violence Neurologic consequences of HIV infection
    17. 17. Trauma Trauma exposure  Prevalent in low-resource countries  Causes: war, economics, gender-issues  Related to depression, anxiety, post-traumatic stress, stigma, distress Gender-based violence  Physical complications – can complicate the woman‟s ability to have children/keep their pregnancy  Burden of having a child from rape  Potential for rejection from husband/family – and abandonment
    18. 18. Overview What is mental health? Mental health issues during pregnancy and new motherhood Effects of mental health issues on mothers, children, and families Risk factors Prevention and Treatment
    19. 19. Prevention Often lack of specialized services Where services exist, generally inadequate to meet population needs Types of programs  Psychoeducation – „what to expect when expecting‟  Social support groups – for sharing experiences  General and specialized (i.e. rape survivors, HIV- infected)  Family services  Economic assistance  Child care
    20. 20. Treatment Psychosocial programming  Social support groups  Social/economic resources Psychological services  Individual therapy  Group therapy Psychiatric services  Pharmaceutical treatment  In/out patient care
    21. 21. Example of an InnovativePrevention Program Caregiver training program to improve neurocognitive development in at risk young children (ages 2-5)  Trialcurrently underway in Uganda with HIV- infected and affected children  Uses home health care visitors to „train‟ caregivers to be more attentive, responsive, and proactive  Preliminary results show impacts child development AND caregiver mental health
    22. 22. Example of an InnovativeTreatment Program Cognitive Processing Therapy (CPT) to treat severe distress among survivors of gender- based violence in Eastern Congo  Many reported rejected by husbands/family – high stigma  Group treatment provided by local psychosocial workers  Preliminary results  Reduced symptoms  Improved functioning – within family and social contacts
    23. 23. Conclusion Problems are real – range from distress to disorder Impact full range of the woman‟s life: self, child, family Recognized risk factors are common in low- resource contexts Prevention programs can be simple – integrated into existing services Treatment programs – possible, need supervision structure but with task-shifting can be implemented in low-resource settings
    24. 24. Acknowledgements Collaborators within the Applied Mental Health Research Group (AMHR)  Paul Bolton, MBBS; Laura Murray, PhD Department Faculty/Students  Tamar Mendelson, PhD; Andrea Vazzano, MPH
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