Reducing psychiatric illness in the perinatal period: A review and commentary

Abstract

This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.

A critical need for the concept of matrescence in perinatal psychiatry

“…By the turn of the 21st century, the field of maternal mental health had grown beyond its myopic focus on child outcomes to encompass a wider classification of diagnoses (e.g., perinatal mood and anxiety disorders or PMADs), clinical windows (e.g., prenatal onset), pathophysiologies (e.g., traumatic childbirth), interventions (e.g., zuranolone), and trainings (e.g., specialized curricula)— this time to alleviate the distress of the mothers themselves ( 9 – 11 ). Epidemiological data revealed that vulnerability in motherhood was ubiquitous with estimates between 15% to 21% of the general population experiencing depression, and up to 80% of mothers reporting distress of some kind ( 12 ). This paradigmatic shift from viewing the mother merely as a functional object to recognizing her as a psychological subject marked a belated but critical turn.…”