Poverty, intimate partner violence, lack of mental health awareness, the related stigma and under-resourced mental health services, contribute to SA’s high rate of maternal depression.
As the country observes National Pregnancy Awareness Week, Dr Bavi Vythilingum, a member of the SA Society of Psychiatrists, said up to half of expectant mothers in SA experience depression during pregnancy and after childbirth that goes undiagnosed and untreated — with risks to their own and their babies’ health and future development.
“While postnatal depression is well-known, depression during pregnancy is almost as common and carries risks of increased complications during pregnancy and childbirth,” she said.
Between 21% and 47% of SA women experience depression during pregnancy, and 31% to 50% suffer postnatal depression, compared to the global rate of about 12% of women experiencing depression during or after pregnancy.
“Pregnancy-related depression is often dismissed as ‘just the baby blues’ and women are told ‘just pull yourself together’, but it is a serious mental health condition which not only negatively affects women’s quality of life and experience of motherhood, but the prospects of the next generation too,” said Vythilingum.
She explained that women who experience stressful life events, and especially intimate partner violence, during pregnancy were more likely to experience long-lasting severe depression that extends from pregnancy through to a year or more after giving birth.
“Antenatal depression increases the risks of hypertension, which puts mother and baby at risk of complications during the pregnancy and in childbirth, and of low birthweight and premature births.
Untreated depression during pregnancy leads to the mother being more likely to experience postnatal depression and difficulties in bonding with her baby, which affects the vital mother-child attachment relationship.
— Dr Bavi Vythilingum
“Untreated depression during pregnancy leads to the mother being more likely to experience postnatal depression and difficulties in bonding with her baby, which affects the vital mother-child attachment relationship. This can affect the child’s social, emotional and cognitive development and lead to mental health problems later in life.
“Depression is one of the greatest risk factors for alcohol and substance abuse during pregnancy, not only worsening the depression but putting the unborn child at risk of developmental delays, congenital abnormalities and intellectual disabilities,” said Vythilingum.
Mental health is often overlooked during pregnancy, she added.
“The lack of awareness and stigma around mental health conditions, along with the tendency to focus more on a woman’s physical health than her mental health during pregnancy, means depressive symptoms are often not picked up. In addition, some of the symptoms of depression, such as changes in sleep patterns, appetite and energy levels, are sometimes simply attributed to the physical changes of pregnancy.
“Because many women in lower income groups, using under-resourced public health services, only access those services during pregnancy, this is often the first time that depressive symptoms are picked up. Antenatal care should go beyond the mother’s physical health to mental health and social needs too, in a holistic, integrated way. This would go a long way in addressing generally high levels of depression, anxiety and other mental health conditions that go undiagnosed and untreated in SA,” said Vythilingum.
Vythilingum said women experiencing moderate to severe depression should ideally be treated with both psychotherapy and medication.
“Ideally, when women have persistently high levels of depression symptoms, an integrated approach should be followed, to deal with pregnancy-related depression, domestic violence if present, and other stressful life events and substance use.
“Group therapy is very helpful, as is the support and interaction, a sense of community and of not being alone, in support groups with other expectant mothers and mothers of newborns. Many clinics, both public and private, have antenatal support groups and there are moms’ support groups active on social media that also meet in person in various centres.”
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