FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4320184837> ?p ?o ?g. }

• W4320184837 endingPage "1" @default.
• W4320184837 startingPage "1" @default.
• W4320184837 abstract "Perinatal psychiatry as a speciality has been gaining recognition in the last decade. Enough evidence has been gathered over years on the impact of maternal mental health on the development of the infant. The perinatal period includes the period during pregnancy, childbirth, and postpartum period. Contrary to the popular belief that pregnancy is considered a the protective period for women in terms of mental health, studies have documented that women do experience mental health problems during the antenatal period. Experiencing mental health problems during pregnancy can put the women at risk for developing postpartum mental health problems. This editorial highlights the perinatal mental health burden and addresses the current status of perinatal mental health services in India. PERINATAL MENTAL HEALTH BURDEN The most common problems experienced during pregnancy include common mental disorders (CMDs) such as anxiety and depression, with varying prevalence rates of 15%–20% in low- and middle-income countries.[1] These untreated disorders affect not only the well-being of the mothers but also affect the growth of the fetus, maternal fetal attachment, and higher risk of obstetric complications.[2] The serious consequence of these disorders can be suicidality. In a study on an Indian cohort of pregnant women, suicidality was noted in 7.6% of mothers. The predictors included younger age, poor perceived support, domestic violence, past history of suicidality, and depressive symptoms.[3] An article in this issue reviews perinatal suicidality. CMDs during the postpartum period can have an impact on breastfeeding practices and maternal infant bonding. In India, a recently published systematic review reported a pooled estimate of the prevalence of antenatal CMDs to be around 22%. The risk factors identified were in the domain of relationships with husband and in-laws and intimate partner violence.[4] The focus has been much on perinatal depression and anxiety disorders have been neglected. A review on anxiety disorders in pregnancy and the postpartum period reported that they are highly prevalent.[5] Anxiety disorders can have specific pregnancy-related presentations with worries related to the health of the infant or the labour. Tokophobia and fear of childbirth can result in undue requests for cesarean section or early termination of pregnancy. A wide range of prevalence of tokophobia has been documented in different settings.[6] Somatic symptoms may be a presentation of underlying depression and anxiety and most screening tools exclude these and hence may not detect CMDs. Perinatal onset obsessive compulsive disorder (OCD) is likely to be higher than in the general population during the perinatal period, with mothers having obsessions related to the harm to the baby and contamination. There could be a worsening of preexisting OCD during the perinatal period either due to drug discontinuation or due to the perinatal period itself. If not detected, it can affect the care towards the infant and impair the mother infant bonding.[7] Childbirth is often considered a positive experience for women; however, a subset of women can experience childbirth to be traumatic. Post Traumatic Stress Disorder (PTSD) related to childbirth is a recognized entity in recent times, with a prevalence of around 4%.[8] The prevalence across countries is highly varied with a study done in the Indian setting reporting a prevalence of PTSD symptoms and PTSD to be 9%.[9] Negative experiences of childbirth can also be related to the kind of care women receive during childbirth within the health systems. Research on the prevalence and manifestations of childbirth-related trauma and its mental health consequences is still in the nascent stage in India. The most severe form of perinatal mental disorder is postpartum psychosis which is a psychiatric emergency with serious consequences for the mother and infant if not addressed early. Mothers with postpartum psychosis need to be treated early in a specialized setting to prevent harm to the infant and mother herself and also to prevent unnecessary separation of the infant from the mother. Catatonia has been reported to be common presentation in postpartum psychosis in the Indian setting.[10] Loss of a child is a difficult event for a mother. Perinatal loss and its mental health consequences are unaddressed as the grief reactions in perinatal loss might have different manifestations from the grief experience during other losses. Countries have developed methods for recognizing and providing interventions for perinatal grief in mothers; however, such interventions need to be studied in our country as cultural differences are likely to be present in the experiences of perinatal grief.[11] With the advent of the new generation of antipsychotics and deinstitutionalization, many women with mental illness are embracing motherhood. Special services are needed to address women with mental illness starting from preconception to parenting services. SCREENING FOR PERINATAL MENTAL HEALTH PROBLEMS Despite the common occurrences and wide range of perinatal mental health disorders, screening for the same is not in the routine practices of health-care systems. Across the world, many developed countries have included screening for mental illnesses among perinatal women as a mandatory assessments. This has involved multiple stakeholders including obstetricians, nurses, and pediatricians. In India, Kerala was the first state to include universal screening for the common mental health problems among perinatal women. In Karnataka, a new initiative has been taken up the government to include screening questions for depression in the “Thayi card” an antenatal record for mothers. The details of mothers have been included in a paper in this issue. The question that we need to ask; is it enough to screen for CMDs during perinatal period? Is it ethical to screen when we do not have streamlining of the services for perinatal women? Who should screen and when should the screening happen? Where should it happen? Should the risk factors for the mental health conditions also be screened for? The answer is to have multilevel, multidisciplinary approach in addressing perinatal mental health problems. A stepped-care approach is the way forward and integrating it with existing health services for pregnant and postpartum women in the community. At the tertiary level, National Institute of Mental Health and Neuro Sciences (NIMHANS) started specialized outpatient services for women in the perinatal period in the year 2006. Women were referred by psychiatrists, obstetricians, or attended the services by themselves. The services provided preconception counseling, handling exposure to psychotropics during pregnancy, and postpartum onset mental illnesses. The services are provided by a multidisciplinary team consisting of psychiatrists, psychologists including developmental psychologists, psychiatric social workers, and nurses. The number of women seeking services has increased gradually over a period of time. A dedicated inpatient 5-bed mother baby unit was started in 2009 to provide joint mother baby admissions to women with perinatal severe mental illnesses. Keeping the cultural traditions, a family member would also be staying with the mother baby dyads. The inpatient team is multidisciplinary providing comprehensive interventions for mother infant dyads. Fathers and grandmothers are encouraged to participate in the care.[12] A helpline was initiated to provide support to mothers who are discharged from the facility for continuity of care.[13] This model might be suitable for tertiary care centers. For general hospitals providing psychiatry care by running joint clinics with obstetricians might be the way to provide perinatal mental health care. Mental health of mothers who have undergone assisted reproduction treatments experience high rates of mental health problems such as anxiety and depression with mother infant interaction difficulties. This is another group that needs great attention! LEGISLATION The Mental Healthcare Act of 2017.[14] Section 21 (2) and (3) state that “a child below 3 years of age shall not ordinarily be separated from his/her mother if the latter is a woman receiving treatment or rehabilitation at a mental health establishment, unless there is a risk to the child from the mother due to her mental illness.” This has been a progressive change in the mental health laws which address the women’s rights. However, this is not supported by services as psychiatrists seem apprehensive about joint admissions or systems have not geared up. If rightly implemented, this could lead to a significant change in the health systems providing care to women with mental illness to provide facilities of mother baby units. This is also a step toward empowerment with mental illnesses. TRAINING To provide specialized perinatal service, training is necessary at the postgraduate level training not only for psychiatry residents but obstetrics trainees as well. A postdoctoral fellowship in women’s mental health was started as an initiative in specialist training in perinatal psychiatry. The Indian Psychiatric Society task force on perinatal mental health has been creating awareness programs on perinatal mental health. Another initiative taken by NIMHANS is to start a certificate course in perinatal mental health. This has been ongoing since 2 years and participants include obstetricians, psychiatrists, psychiatric social workers, psychologists, and nurses. The course includes didactic lectures, case presentations by participants, and structured assessments at the end of the course.[15] Mental health of mothers is focussed more on identifying psychiatric disorders and treatment. With increasing focus on suicidality in the perinatal period, services need to gear up to provide support for our mothers. Changes in the mental health laws, obstetric care facilities, and more trained human resources should reflect better care for our mothers. Investing in mental health of mothers has a great impact on well-being of the child and the family. More focus is also needed on preventive aspects in perinatal mental health. Karnataka has taken the lead to include screening for depression in the perinatal period in the public sector and hope this spreads to other states as well. Father’s mental well-being in the perinatal period is often ignored. Fathers are screened for depression in the perinatal period in some countries but are not paid attention in our systems. Developing culturally sensitive models of care with delivery by nonspecialists is the way forward to improve mother infant well-being. If we want to prevent mental illness in future, it is the time to invest in mental health of mothers!" @default.
• W4320184837 created "2023-02-13" @default.
• W4320184837 creator A5006108687 @default.
• W4320184837 creator A5054553509 @default.
• W4320184837 date "2023-01-01" @default.
• W4320184837 modified "2023-10-07" @default.
• W4320184837 title "Perinatal mental health in India: Time to deliver!" @default.
• W4320184837 doi "https://doi.org/10.4103/jopsys.jopsys_3_23" @default.
• W4320184837 hasPublicationYear "2023" @default.
• W4320184837 type Work @default.
• W4320184837 citedByCount "0" @default.
• W4320184837 crossrefType "journal-article" @default.
• W4320184837 hasAuthorship W4320184837A5006108687 @default.
• W4320184837 hasAuthorship W4320184837A5054553509 @default.
• W4320184837 hasBestOaLocation W43201848371 @default.
• W4320184837 hasConcept C118552586 @default.
• W4320184837 hasConcept C134362201 @default.
• W4320184837 hasConcept C15744967 @default.
• W4320184837 hasConcept C71924100 @default.
• W4320184837 hasConcept C99454951 @default.
• W4320184837 hasConceptScore W4320184837C118552586 @default.
• W4320184837 hasConceptScore W4320184837C134362201 @default.
• W4320184837 hasConceptScore W4320184837C15744967 @default.
• W4320184837 hasConceptScore W4320184837C71924100 @default.
• W4320184837 hasConceptScore W4320184837C99454951 @default.
• W4320184837 hasIssue "1" @default.
• W4320184837 hasLocation W43201848371 @default.
• W4320184837 hasOpenAccess W4320184837 @default.
• W4320184837 hasPrimaryLocation W43201848371 @default.
• W4320184837 hasRelatedWork W2012178436 @default.
• W4320184837 hasRelatedWork W2154913456 @default.
• W4320184837 hasRelatedWork W2184085383 @default.
• W4320184837 hasRelatedWork W2207934733 @default.
• W4320184837 hasRelatedWork W2280850722 @default.
• W4320184837 hasRelatedWork W2386276313 @default.
• W4320184837 hasRelatedWork W2435230023 @default.
• W4320184837 hasRelatedWork W2468209686 @default.
• W4320184837 hasRelatedWork W2748952813 @default.
• W4320184837 hasRelatedWork W2899084033 @default.
• W4320184837 hasVolume "2" @default.
• W4320184837 isParatext "false" @default.
• W4320184837 isRetracted "false" @default.
• W4320184837 workType "article" @default.