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Perinatal period: The perinatal period is defined as the time from the beginning of pregnancy through childbirth, to the end of the first year of being a parent. Mental illness: ‘Mental illness’ is a general term used to refer to any psychological or emotional disorder, illness or condition which prevents a person from functioning ‘normally’. It is when a person’s normal thought processes, emotional, or behavioural functioning is disrupted by physical, psychological or social factors. The terms ‘mental disease’ or ‘mental disorder’ may also be used. ‘Mental distress’ refers to the same except the symptoms may not be severe enough to qualify for the diagnosis of a ‘disorder’ or ‘disease’. Perinatal mental illness: Mental illness during the perinatal period is common, with depression and anxiety being the most frequently occurring disorders. This is a stressful time, so feeling 'down' or anxious is understandable. However, if these feelings become so severe that they interfere with a woman’s daily life, then it is possible that she is suffering from a mental illness. It is especially common for a new mother to feel emotional after childbirth. This is usually a temporary psychological state characterised by sudden mood swings, feeling very happy, then very sad, crying for no apparent reason and feeling impatient, unusually irritable, restless, anxious, lonely and sad. We call these feelings the ‘baby blues’. They may last only a few hours or as long as 1 to 2 weeks after delivery. It is important not to confuse the ‘baby blues’ with postnatal depression. ‘Baby blues’ may not always require treatment, but more serious conditions like depression or anxiety do. It is important to note that many of the usual physical symptoms of pregnancy are similar to mental health problems, such as sleep and appetite changes, aches and pains, tiredness or changing emotions. A pregnant woman or mother may be suffering from a mental illness if she experiences any or a combination of the following:
A mother experiencing emotional distress may
Serious mental illnesses are better understood when listing symptoms on a continuum. Risk factor: A risk factor is a characteristic, condition or behaviour that increases a person’s chances of developing a disorder or disease. For example, high blood pressure, high cholesterol and smoking are risk factors for a heart attack. Lack of support at home, an HIV-positive diagnosis, unemployment and past mental illness are risk factors for depression. Psychosocial factors: This refers to looking at a person's social circumstances and environment to identify possible contributing factors for mental illness. Depression: Depression is a type of mental illness. It is one of the ‘mood disorders’. Symptoms can include:
In more serious cases the above symptoms could be accompanied by suicidal thoughts or an attempt to commit suicide.
Anxiety: An abnormal and overwhelming sense of apprehension and fear of an upcoming event or ‘threat’. It is also a 'mood disorder'. It may be accompanied by:
Depression and anxiety can present as illnesses on their own, or in combination, which means some women may present symptoms for both depression and anxiety. Obsessive-compulsive disorder (OCD): OCD is a mental illness which is one of the anxiety disorders. It can range from mild to severe. If severe and left untreated, OCD can destroy a person’s capacity to function at work, school or home. OCD is one of the more common mental illnesses occurring during the perinatal period. Women already suffering from OCD are likely to experience a worsening of symptoms at this time. Persons with OCD experience ‘obsessive’ or unwanted thoughts that occur repeatedly in their mind. Examples include:
The person experiences the disturbing thought again and again. For example, ‘my hands may be contaminated - I must wash them’; ‘I may have left the stove on’; or ‘I am going to injure my child.’ These thoughts intrude and interfere in the person’s daily life. They are very unpleasant, and they produce high levels of anxiety. These obsessions cause the person with OCD to act out repetitive or ‘compulsive’ behaviours, such as
A person with OCD cannot control these behaviours – they are involuntary. The person with OCD performs them in the belief that these actions will prevent harm to herself or others, such as her child. Other repeated behaviours include: counting, making lists, repeating phrases to herself, or following certain patterns of behaviour. These patterns may provide relief from anxiety for a little while, but this relief is only temporary. OCD may be accompanied by depression, eating disorders, substance abuse, attention deficit disorder, or another anxiety disorder.
Tocophobia: Tocophobia is when a woman experiences an abnormal and persistent fear of childbirth. This ‘fear’ is also called a ‘phobia’. A ‘phobia’ is a common type of anxiety disorder. It refers to an unreasonable fear that can cause panic and avoidance.
Tocophobia may lead to a frightening or traumatic delivery
If early therapy (counselling) is not possible, it may be best to refer the patient for an elective Caesarean section. Avoidance: Avoidance is to pretend that the problem does not exist, not taking responsibility for the problem or denying that the problem exists.
Post-traumatic stress disorder (PTSD): PTSD is a common anxiety disorder that develops after experiencing or witnessing a terrifying event, or enduring extreme hardship. Examples could be a sexual or physical attack, the unexpected death of a loved one, an accident, war, torture or a natural disaster. The event is accompanied by serious physical, emotional or psychological harm, or the threat of harm. Because pregnancy is such an intense psychological and physical experience, all kinds of abuse-related memories and emotional reactions can come to the surface. Pregnancy can act as a trigger for past traumas. PTSD has been linked with pre-term delivery. Risk factors
Symptoms
The person will have one or more symptoms from each of the following categories which are present for at least a month and seriously interfere with her ability to lead a normal life.
a. Re-living the event
b. Avoiding
c. Increased excitability
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