maternal depression heart reading pack
TRANSCRIPT
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Maternal Mental Health: Overview of the HEART Reading Pack
Prof Crick LundDepartment of Psychiatry and Mental Health
University of Cape TownEmail: [email protected]
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What is depression?1
Core requirements:• Depressed mood (feels sad, empty or hopeless)• Loss of interest and enjoyment/pleasure• Reduced energy leading to increased fatigue and diminished activity. Plus 3 or more of the following: significant weight gain/loss; insomnia/hypersomnia; psychomotor agitation/retardation; feeling excessively worthless/guilty; diminished ability to think/concentrate; recurrent thoughts of death/suicideNote: • Symptoms must cause clinically significant distress or impairment in
social, occupational or other important areas of functioning• Symptoms must persist for at least a 2 week period (major depressive
episode)
1. DSM-5, American Psychiatric Association, 2013; ICD-10, WHO, 2010
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What is maternal depression?
• Depression experienced by a mother during pregnancy or the postnatal period (first 12 months of her baby’s life)
• The experience of maternal depression may vary substantially across cultures, and is expressed in various idioms of distress, e.g.:– kufungisisa “thinking too much” in Zimbabwe– ukudakumba “being sad or unhappy” and ucingakakhulu
“thinking too much” in South Africa– yandimukuba “being struck by pressure” in Uganda
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Why should we treat maternal depression?
The burden of Common perinatal mental disorders (depression and anxiety) is high:
– High income countries: 13% (antenatal); 10% (postnatal)
– Low and middle-income countries: 16% (antenatal) ; 20% (postnatal)
Fisher et al 2012
Photo: Alexia Beckerling
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Why should we treat maternal depression?Prevention: intergenerational impact
Antenatal distress Postnatal distress• Chronic mental illness• Drugs / alcohol• Suicide/Infanticide
ChildInfancy• Emotional
problems• Cognitive
problems• Poor growth• Diarrhoeal
disease• Malnutrition
Childhood / Adolescence• Mental health problems• Impaired mother-child
relationships
Mother
Poor bonding
Dysfunction may influence
the next generation
Trans-placental
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Risk Factors
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Why should we integrate?The good news
• Unique opportunities for health system contact with mothers– Antenatal Care– Postnatal Care
• Evidence for effective treatment– Low resource settings (India, Pakistan, Chile) –
WHO Thinking Healthy Manual– The Perinatal Mental Health Project model
(South Africa) • Efficient investment for child outcomes
(Heckman’s model)
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Investment hypothesis
Investing in Early Human Development: Timing and Economic Efficiency Orla Doyle, Colm P. Harmon, James J. Heckman,and Richard E. Tremblay Econ Hum Biol. 2009 March; 7(1): 1–6.
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Steps to integrating mental health care into routine maternal health care • Select a suitable locally relevant screening or
detection tool. • Adapt and translate the screening tool if
necessary.• Conduct a needs assessment.• Based on the identified need, design a
stepped care approach, appropriate to local setting:– Step 1: Routine or selected antenatal and
postnatal screening– Step 2: Screen positives referred for evidence-
based counseling– Step 3: Referral of mothers who are not
responsive to counseling for assessment by medical doctor for potential anti-depressant medication.
Photo: PMHP
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Cautionary notes
• Consider options for screening tools carefully.
• 5-day training using the WHO Thinking Healthy manual
• Ongoing supervision of counselors is essential!
• Select counselors carefully based on:– Personal capacity for empathy– Motivation– Skills