Pregnancy outcomes, early separation and psychiatric relapse experienced by South African women with peripartum psychosis: A descriptive exploration

Abstract

Background: The peripartum period is associated with increased incidence of severe mental illness (SMI), with a greater occurrence of psychotic symptoms and psychiatric admissions. There has been little research on South African mothers with peripartum psychosis to examine what factors contribute to their experiences of pregnancy and the postpartum period. This study aimed to explore the relevant socio-demographic factors and pregnancy outcomes in order to determine focus areas for intervention. Methods: Using a prospective, descriptive design, we conducted a detailed interview and supplementary information was collected by review of clinical records. The study examined the accounts of thirty-two mothers who experienced peripartum psychosis between 6 and 18 months postpartum. Areas of focus included participants’ current circumstances, their pregnancy, birth and postpartum experiences. Results: The majority of mothers were diagnosed with bipolar disorder and all but one have had one psychiatric admission. Pregnancies were predominantly unplanned (87.5%) and half of participants reported substance use during pregnancy. Medical or psychiatric problems during pregnancy occurred in 68.8% of pregnancy and 71.9% of mothers reported complications with delivery. Common psychosocial stressors included trauma, lack of partner support and financial hardship. Early separation occurred in 56.3% of dyads, mostly due to psychiatric admission. Conclusion: Our study describes psychiatric, medical and psycho-social risk factors affecting mothers who experienced peripartum psychosis. We discuss the implications of the findings for a developing country where there exists a lack of integrated maternal and infant mental health services. The results highlight the need for close obstetric and psychiatric follow-up for women with serious mental illness, with particular attention to screening for substance use and psychosocial stressors.

Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants

“…The presence of mental illness in a partner or family member should also be cited as demographic factors [ 40 ]. Data collected in South Africa indicate socio-demographic problems and psychoactive substance use as risk factors [ 70 ].…”

“…It is necessary to search for environmental and cultural causes of PP-related infanticide [ 84 ]. There are no reliable data on the prevalence of PP in Africa, where it is a serious problem [ 70 ].…”

Psychosis risk among pregnant women in Ghana

“…Data on the prevalence of psychosis in pregnancy is limited in Africa owing to lack of studies. Previous studies addressing this topical issue have focused on the factors contributing to the development of mental health issues, including psychosis, post-delivery [ 6 ].…”

“…While the foregoing suggests that studies elucidating PLEs in pregnancy are extremely important, our understanding of psychosis risk in pregnancy is limited largely because the existing studies have overwhelmingly focused on persons who have been diagnosed with psychotic disorders [ 5 , 8 – 10 ]. For example, in their study involving 40 mothers diagnosed postpartum psychosis in South Africa, Voges et al found that substance use during pregnancy, postpartum abuse and lifetime experience of trauma were reported by the participants [ 6 ]. Understanding the prevalence and correlates of PLEs in the perinatal period can strategically support healthcare professionals in their effort to render basic mental health services to pregnant women.…”

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“…While the foregoing suggests that studies elucidating PLEs in pregnancy are extremely important, our understanding of psychosis risk in pregnancy is limited largely because the existing studies have overwhelmingly focused on persons who have been diagnosed with psychotic disorders [5,[8][9][10]. For example, in their study involving 40 mothers diagnosed postpartum psychosis in South Africa, Voges et al found that substance use during pregnancy, postpartum abuse and lifetime experience of trauma were reported by the participants [6]. Understanding the prevalence and correlates of PLEs in the perinatal period can strategically support healthcare professionals in their effort to render basic mental health services to pregnant women.…”