Pregnant and depressed?
Routine mental health tests should be done on pregnant women, says a Cape Town research project.
Mental health screening of pregnant women is routine in the UK, Canada and the USA. Doing the same in South Africa could alert women to the need to seek supportive counselling – and potentially reduce our unusually high number of post-natal depression cases.
Thandi van Heyningen, Clinical Psychologist & Research Coordinator for the Perinatal Mental Health Project, based at the University of Cape Town, offers these answers.
Is post-natal depression on the rise in South Africa?
There is limited information about antenatal and postnatal depression available in South Africa as very few studies have been done. Data from a few relatively recent studies show a level between 34 and 48%. This is much higher than the 7 - 18% range for higher income countries.
In South Africa, poverty plays a big role in increasing vulnerability to depression and there is evidence to link depression to HIV.
Coupled with this are other factors which contribute to women's vulnerability to depression during this period: lack of social support; gender inequalities; abusive relationships and gender-based violence; and substance abuse are all contributing risk factors. Two other important factors that make women vulnerable are teenage pregnancy and refugee status.
How are women affected by depression?
Clinical depression has a marked impact on one's ability to function. Depression affects one’s thinking and behaviour, it affects the ability to make rational decisions, to plan and also how one views the world.
It becomes inordinately difficult to engage with potential resources or support structures in one's world. In these states, it is nearly impossible to make clear decisions; to weigh up the options and consider the consequences.
In extreme (and rare) cases, where a woman becomes psychotic, she may become completely detached from reality and lose all ability to make rational judgements.
Why should pregnant women be tested for mental illness?
Depression is highly prevalent amongst pregnant women and there are studies to show that post natal depression and other common mental disorders can be prevented if you screen and treat a woman during her pregnancy.
In South Africa, many women struggle to access health services. However, during pregnancy more than 90% of women will attend a clinic for antenatal care in South Africa . This provides a unique opportunity for intervention and for mental health services to be delivered as part of antenatal care, as an integrated package of care. This is very important in areas where there are few resources available.
The benefits of this are the prevention of more serious disorders developing and there are many positive effects for the mother, her infant, her other children and the community as a whole.
Prevention and early intervention are also much more cost-effective than having to take a treatment-orientated approach.
What would these mental health tests consist of?
The global evidence points to the need to screen for current symptoms of common mental disorders (such as depression and anxiety) as well as the need to screen for risk factors (background factors that make the woman more vulnerable to mental illness).
At the Perinatal Mental Health Project, we use the Edinburgh Postnatal Depression Scale and an 11-item risk factor assessment. After having the score calculated by the midwife, if a woman needs it, she will be offered counselling and a referral will be made to the on-site counsellor or clinical psychologist or to a psychiatrist if necessary.
Did you suffer from depression while pregnant or afterwards? Do you think this screening is necessary?