Help-seeking patterns in women with postpartum severe mental illness: a report from southern India

Abstract

Postpartum severe mental illness (SMI) often presents with risks to mother-infant dyad and requires early assessment and interventions. The access to psychiatric care in low and middle income countries is complex. Help-seeking patterns in women with postpartum SMI has not been studied adequately. Hence, the present study was undertaken to examine the help-seeking pattern and reasons for delay in seeking psychiatry services among postpartum women with SMI. Successive patients with a diagnosis of postpartum SMI were recruited over a period of 2 years. Clinical variables including the risk evaluation, perceived delay in seeking care along with the reasons were assessed through clinical interviews using a proforma. Severity of illness was assessed using BPRS and "encounter" form was used to assess the help-seeking pattern. One hundred twenty-three women with postpartum SMI participated in the study. Acute polymorphic psychotic disorder was the most common clinical presentation. Psychiatrists were the most commonly (52.8%) sought care providers followed by faith healers (26%) and general medical practitioners (GMP) (21.1%) at the first level of help seeking. A past history of psychiatric illness was significantly higher among those who first contacted a psychiatrist, and BPRS scores were significantly high among those who contacted a GMP. Forty-four percent of subjects perceived a delay in seeking care from psychiatry services and the most common reason was lack of resources. There is a need to enhance awareness about postpartum SMI in the community. Faith healers need to be sensitized about the associated risks and the need for early referrals. Addressing the barriers to psychiatric care would help in early detection and treatment of postpartum SMI.

Perinatal mental health around the world: priorities for research and service development in India

“…Clinical research has focused on psychopathology, suicidality, mother-infant bonding and patterns of help-seeking among mothers with more severe forms of mental illness. [6][7][8]…”

Sense of Coherence, Social Support, Maternal-Fetal Attachment, and Antenatal Mental Health: A Survey of Expecting Mothers in Urban India

“…Possible explanations for these high rates are greater stigma attached to mental health care and a lack of awareness about perinatal mental health among practitioners and mothers, which subsequently impacts prevention and treatment of mental health concerns (12,13). Furthermore, the current understanding of perinatal mental health in India is largely based on a medical model and symptomfocused approach (14)(15)(16). While these approaches have allowed researchers and practitioners to delineate mental illnesses specific to this period, and devise appropriate interventions (17)(18)(19), it seems necessary to add to this literature by expanding conceptions of mental health to include subjective experiences of mothers in the domains of psychosocial and individual factors.…”

Stigma and Perceived Threat Regarding Peripartum Depression among Pregnant Women in a “Pregnancy Friendly” Community

“…Stigma regarding PPD in the at-risk population i.e; pregnant and postpartum women is another important factor as stigma held as an unaffected person might operate as perceived, internalized or anticipated stigma if the person is affected. All of these types have been shown to interfere with help seeking for the disease, diagnosis acceptance and treatment adherence [6,7,[16][17][18][19][20][8][9][10][11][12][13][14][15]. On the other hand, studying stigma among pregnant women can provide a valuable insight about their community, with which they share the belief systems.…”