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Table of Contents
CONCEPT ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 49-51

Maternal mental health and role of nurse


Department of Mental Health Nursing, College of Nursing, AIIMS, New Delhi, India

Date of Web Publication14-Oct-2019

Correspondence Address:
Dr. Sandhya Gupta
Department of Mental Health Nursing, College of Nursing, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_16_19

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  Abstract 


One in five women suffers from depression, anxiety, or both while pregnant or after giving birth, negatively impacting the mother and the child. Despite this high prevalence of mental health issues, few women receive treatment. Health workers working with pregnant and lactating women need to better understand this issue and to explore innovative, practical solutions for delivering mental healthcare to mothers and expectant mothers in need. They include prenatal and postpartum depression and/or anxiety. Conclusion: Overall, psychosocial and psychological interventions are effective treatments for postpartum depression. All interventions have to be face to face and provided by a health professional.

Keywords: Maternal health, mental health, role of nurse


How to cite this article:
Gupta S. Maternal mental health and role of nurse. Indian J Psy Nsg 2019;16:49-51

How to cite this URL:
Gupta S. Maternal mental health and role of nurse. Indian J Psy Nsg [serial online] 2019 [cited 2019 Nov 22];16:49-51. Available from: http://www.ijpn.in/text.asp?2019/16/1/49/269159




  Introduction Top


One in five women suffers from depression, anxiety, or both while pregnant or after giving birth, negatively impacting the mother and the child. Despite this high prevalence of mental health issues, few women receive treatment.[1]

Health workers working with pregnant and lactating women need to better understand this issue and to explore innovative, practical solutions for delivering mental healthcare to mothers and expectant mothers in need.[2] Perinatal mood and anxiety disorders are the most common medical complications affecting women during pregnancy and after childbirth. They include prenatal and postpartum depression and/or anxiety, and in extreme cases, postpartum psychosis.[3]

Maternal mental health problems affect up to 20% of women, with potentially deleterious effects on the mother and family. The prevalence is estimated to be even higher in some populations. For example, one in four mothers in the state reports depressive symptoms, and so do as many as half of all mothers living in poverty.[4]

If left undetected and untreated, these conditions can lead to negative health outcomes for the mother and can negatively affect the mother–child bond and the child's long-term physical, emotional, and developmental health. In addition, the financial cost of untreated maternal mental health conditions can be significant.[5]

The Cochrane review summarized the results of 15 trials involving 7697 women. The review found that women who received preventive psychosocial interventions were just as likely to experience postpartum depression as those who received standard care.[6]

The interventions included antenatal and postnatal classes, home visits by laypersons, early postpartum follow-up, application of continuity-of-care models, in-hospital psychological debriefing, and interpersonal psychotherapy. Thus, at present, there is no evidence for these practices to be recommended for the prevention of postpartum depression.

The interventions with only a postnatal component appeared to be more beneficial than interventions that also incorporated an antenatal component. While individually based interventions may be more effective than those that are group based, women who received a multiple-contact intervention were just as likely to develop postpartum depression as those who received a single-contact intervention. Likewise, these preventive interventions had no effect on other maternal outcomes, including health service contact, maternal–infant attachment, attitudes of mothers toward motherhood, maternal competence, general physical and mental health, perceived support, breastfeeding duration, and marital discord. Low socioeconomic status affects many women and their families in developing countries. Hence, women in this setting may be more at risk of developing postpartum depression. There is a need to develop effective interventions targeting mothers in such settings.

To address this serious problem, a maternal mental health program using a shared care approach must be developed. A shared care approach can promote efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental healthcare services, and promote primary care provider competence in treating maternal mental health problems. A shared care approach needs to be evaluated for its effect on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach. Training needs to be given to all front line workers, Auxiliary Nurse Midwives (ANMs), public health workers, medical officers and residents, interns' public health nurses, and staff nurses to evaluate women's depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program. Finding depression and anxiety symptoms will significantly improve with involvement with the program. Shared care can be an effective and efficient way to provide maternal mental health care in primary healthcare settings where resources are limited.[7]


  Types of Interventions Top


Psychosocial and psychological interventions

Psychosocial and psychological interventions include psychoeducational strategies, cognitive behavioral therapy (CBT), interpersonal psychotherapy, psychodynamic therapy, nondirective counseling, various supportive interactions, and tangible assistance, delivered via telephone, home, or clinic visits, or individual or group sessions in the postpartum by a health professional or layperson. Psychosocial interventions are unstructured and include the following approaches.

Cognitive behavioral therapy

CBT is an approach based on the notion that the way an individual perceives an event determines in part how they will respond, both affectively and behaviorally (Hollon, 1998). According to cognitive theory, dysfunctional beliefs and maladaptive information processing lie at the core of many psychiatric disorders. As such, CBT assists individuals in identifying and correcting erroneous beliefs and systematic distortions in information processing with the hopes of reducing distress and enhancing coping efforts.

Interpersonal therapy

Interpersonal therapy (IPT)

IPT was initially formulated as a time limited, weekly outpatient treatment for depression provided by a trained mental health professional (Klerman, 1993). While this method makes no assumption about etiology, the connection between depressive symptomatology onset and interpersonal problems is used as a treatment focus. IPT is an acute treatment that generally has three phases: (1) diagnosis evaluation, psychiatric/social history (including current social functioning and close relationships, their patterns, and mutual expectations), and linkage between the current interpersonal situation within one of the four interpersonal problem areas (i.e., grief, interpersonal role disputes, role transitions, or interpersonal deficits) to set the framework for treatment; (2) pursuit of strategies (defined in the IPT manual) that are specific to the chosen interpersonal problem area; and (3) encouragement to recognize and consolidate therapeutic gains and develop ways to identify and counter depressive symptoms should they arise again in the future.

Psychodynamic therapy

Psychodynamic therapy, also known as insight-oriented therapy, focuses on unconscious processes as they are manifested in a person's present behavior. The goals of psychodynamic therapy are an individual's self-awareness and understanding of the influence of the past on present behavior. In its brief form, a psychodynamic approach enables the individual to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships.[6]

Several different approaches to brief psychodynamic psychotherapy have evolved from psychoanalytic theory and have been clinically applied to a wide range of psychological disorders including depression.

Standard or usual care

Standard or usual care includes any appropriate medical care received including pharmacotherapy as deemed necessary by a clinician.


  Types of Outcome Measures Top


Primary outcome measures

The primary outcome measure in this review was evidence of both recovery (dichotomous outcome) and reduction in depressive symptomatology (continuous outcome) (as variously defined and measured by any of the scales, e.g., Beck Depression Inventory).[8]

Secondary outcome measures

Maternal outcomes

  1. Maternal mortality and serious morbidity including self harm and suicide attempts
  2. Health service utilization, including outpatient and inpatient use of psychiatric unit, other health services
  3. Maternal–infant attachment
  4. Maternal attitudes toward motherhood
  5. Anxiety (e.g., State Trait Anxiety Scale)
  6. Stress
  7. Maternal confidence
  8. Maternal competence
  9. Self esteem
  10. General health
  11. Dissatisfaction with intervention
  12. Perceived social support.[4]


Infant outcomes

  1. Breastfeeding duration (variously defined)
  2. Breastfeeding level (exclusive, almost exclusive, high, partial, token, bottle-feeding)
  3. Infant health parameters including immunization, accidental injury, nonaccidental injury
  4. Infant developmental assessments (variously defined)
  5. Child abuse and/or neglect
  6. Neonatal/infant mortality
  7. Neonatal/infant morbidity
  8. Quality of mothering.


Family outcomes

  1. Marital relationship (e.g., Dyadic Adjustment Scale)
  2. Marital separation/divorce.



  Role of Nurse Top


Fortunately, these conditions are treatable, and early detection can make a significant, positive impact. State mental health authority is taking initiatives in training primary healthcare workers to better understand maternal mental healthcare in and to explore ways that it can be improved.[9]

There is a range of different types of psychosocial support that may be provided in the perinatal period. This may include lifestyle advice, nondirective counseling, discussing emotional health and well-being, facilitating practical support, and informing the woman of psychosocial support options in her community (e.g., peer support, support groups, and playgroups).[10]

The success of these interventions depends on effective woman-centered communication.


  Conclusion Top


Overall, psychosocial and psychological interventions are effective treatments for postpartum depression. All interventions have to be face to face and provided by a health professional except for one trial that provided telephone-based peer support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev 2013;2:CD001134.  Back to cited text no. 1
    
2.
Beck CT. Predictors of postpartum depression: An update. Nurs Res 2001;50:275-85.  Back to cited text no. 2
    
3.
Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev 2007;4:CD006116.  Back to cited text no. 3
    
4.
World Health Organization. Maternal Mental Health and Child Health and Development in Low and Middle Income Countries. Report of the WHO Meeting. Geneva: World Health Organization; 2008.  Back to cited text no. 4
    
5.
Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet 2007;370:859-77.  Back to cited text no. 5
    
6.
Golding JM. Intimate partner violence as a risk factor for mental disorders: A meta analysis. J Fam Violence 1999;14:99-132.  Back to cited text no. 6
    
7.
World Health Organization. Gender Disparities in Mental Health. Geneva: World Health Organization; 2001.  Back to cited text no. 7
    
8.
Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W. Depression and anxiety during pregnancy: A risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 2007;20:189-209.  Back to cited text no. 8
    
9.
Oates M. Perinatal psychiatric disorders: A leading cause of maternal morbidity and mortality. Br Med Bull 2003;67:219-29.  Back to cited text no. 9
    
10.
Miranda JJ, Patel V. Achieving the millennium development goals: Does mental health play a role? PLoS Med 2005;2:e291.  Back to cited text no. 10
    




 

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  In this article
Abstract
Introduction
Types of Interve...
Types of Outcome...
Role of Nurse
Conclusion
References

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