The following news story appeared in Essentially MIDIRS, vol 4, no 11, December 2013, p24
Funded by Boots Family Trust Alliance and created in association with Netmums, the Institute of Health Visiting, the RCM and the charity Tommy’s, a new report — Perinatal mental health experiences of women and health professionals (Boots Family Trust Alliance et al 2013) — highlights that the pressure to be a successful mother is one of the main contributors to the development of pre- and postnatal anxiety and depression.
The report presents findings of a survey of the experiences of over 2000 health professionals, and 1500 mothers who suffered from depression during or after pregnancy, and it suggests that the symptoms are often severe:
• 43% did not want to leave the house
• 22% had suicidal thoughts
• 30% reported that their symptoms lasted for more than 18 months.
Perhaps more worryingly, three out of four women felt unable to reveal the full extent of their symptoms to a health professional, many because of the fear that their baby would be taken away from them. Other reasons for failure to disclose included a lack of continuity in care, with women reporting that they saw different health visitors or midwives at each appointment, and many because they were too embarrassed to admit to it. Forty per cent of the women surveyed did not receive any treatment.
When asked what they thought may have contributed to their state of mind:
• 22% of women cited pressure to do things right
• 21% identified a lack of practical and emotional support
• only 12% believed that their state of mind was influenced by their hormones
• and 15% thought that they had a pre-disposition to anxiety or depression.
Current NICE guidelines (NICE 2007) recommend the use of Whooley questions as a tool to identify depression, ie, ‘During the past month, have you often been bothered by feeling down, depressed or hopeless? During the past month, have you often been bothered by having little interest or pleasure in doing things?’ (NICE 2007: 38-9), but the health professionals surveyed reported using a variety of diagnostic tools and expressed doubts as to whether Whooley questions are sophisticated enough to be effective in many cases.
The organisations associated with the report have called for measures to be put in place in three key areas to help combat the problem:
- Diagnosis: a suitable approach needs to be agreed for different professionals working in different clinical settings, and a minimum standard of training provided for identifying symptoms.
- Continuity of care: commissioners should consider the way services are structured to maximise continuity of care, and ensure that midwifery and health visiting services have sufficient staff with the time and skills to provide care for those experiencing mental health problems.
- The routine use of a well-being plan: would achieve a greater awareness and openness about mental health issues during pregnancy and after birth and help both parents and health professionals to discuss the subject and recognise any symptoms and support needed early on.
The poor uptake of treatment for postnatal depression also triggered a pilot study, carried out by the University of Exeter (O’Mahen 2013), into the effectiveness of an internet-based therapy treatment. Many mothers reported a preference for therapy over drug-based solutions, but accessing services can be difficult, particularly in the postnatal period when feeding and sleeping times, transportation and childcare issues may make it hard to keep appointments.
On average, women assigned to the modular online therapy completed eight out of 12 telephone support sessions and five out of 12 modules. Improvements on depression, work and social impairment and anxiety scores were found post-treatment and a positive effect on depression at six months post-treatment, suggesting that this may be method of treatment is accessible and may have beneficial effects.
Boots Family Trust Alliance, Netmums, Institute of Health Visiting et al (2013). Perinatal mental health experiences of women and health professionals. http://tinyurl.com/pzgj62e [Accessed 29 October 2013].
NICE (2007). Antenatal and postnatal mental health: clinical management and service guidance. London: NICE.
O’Mahen HA, Richards DA, Woodford J et al (2013). Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychological Medicine 23 October [Online ahead of print]. http://tinyurl.com/ogrhm7j
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