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Perinatal Mental Health Around the World

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Perinatal Mental Health Around the World THEMATIC Perinatal mental health around the PAPER world: priorities for research and service development in China Simone Eliane Schwank,1 Qiongjie Zhou,2 Yanling He3 and Ganesh Acharya4 1PhD, MS, MA, Msc, Clinical Perinatal mental health in China psychologist, Department of China’s healthcare is improving together with Clinical Science, Intervention and rapid economic growth. Yet, mental Perinatal mental disorders, including suicide, are Technology (CLINTEC), emerging as a major cause of maternal mortality Karolinska Institutet, Stockholm, healthcare is lagging behind. Prevalence of Sweden. perinatal depression is high among women of in both high- and low-income countries. In Email: [email protected] the one-child generation, but access to China, however, community members rarely con- 2MD, Specialist Obstetrician, – qualified care is limited. Chinese healthcare sider mental illness a direct cause of suicide it is Obstetrics and Gynaecology fl Hospital, Fudan University, professionals, policy makers and patients typically seen as the result of family con ict or Shanghai, China alike express concerns about insufficient other social stressors. Exact national statistics on 3MD, MintMH, Director, perinatal mental disorders are not available for Department of Psychiatric knowledge among the public as well as Epidemiology, Shanghai Mental healthcare providers regarding mental China, but mental illness-related maternal mortal- Health Centre, Shanghai Jiao ity is reported to be negligible in Shanghai.7 The Tong University School of disorders. There appears to be a general lack Medicine, China of help-seeking behaviour for mental disorders results of a recently published retrospective study 4MD, PhD, FRCOG, Professor and owing to perceived risk of social on postpartum depression among Chinese women Head, Division of Obstetrics and are consistent with previous findings that the Gynaecology, Department of stigmatisation. Social support through family Clinical Science, Intervention and and friends, use of online resources and majority (84%) of cases of postpartum depression Technology (CLINTEC), community healthcare services are preferred, occur within 6 weeks after childbirth and up to Karolinska Institutet, Stockholm, fi 8 Sweden rather than seeking help from mental health 94% within the rst 4 months postpartum. This specialists. indicates higher risk for developing postpartum Conflicts of interest: None. depression soon after childbirth, which is similar to Western countries, despite the tradition of famil- Keywords. Perinatal psychiatry; fi ‘ anxiety disorders; community ial support and rest after con nement, doing the mental health teams; psychiatric month’ (zuo yue zi). ‘Doing the month’ is family- nursing; stigma and It has been estimated that 39.6 million healthy discrimination. life-years will be lost in China by 2025 because based care during the period immediately after of mental illnesses (the estimate is based on dis- delivery, with the purpose of helping the mother First received 19 Jul 2019 1 to go through the physical and psychological Final revision 19 Dec 2019 ability adjusted life-years, or DALYs). The preva- Accepted 20 Jan 2020 lence of mental disorders reported by the recent adjustments. Its main components include avoid- fi Chinese Mental Health Survey was higher than ing cold, adequate rest, suf cient cleanliness, a doi:10.1192/bji.2020.5 that reported in the previous two large-scale sur- balanced diet, pelvic recovery and nutrient supple- veys from China and there are substantial gaps in ments, believed to restore maternal postpartum © The Authors 2020. This is an 9 ‘ ’ Open Access article, distributed the accessibility of care.2 The number of epi- health. In China, doing the month has been con- under the terms of the Creative sidered to have both a positive and negative impact Commons Attribution licence demiological studies on mental health in China 10 (http://creativecommons.org/ is relatively small. Basic data on many mental dis- on maternal well-being. licenses/by/4.0/), which permits unrestricted re-use, distribution, orders, populations and regions are still missing. and reproduction in any medium, There are so many knowledge gaps in this field Risk factors for perinatal depression in provided the original work is fi China properly cited. that an attempt to ll even one or two of these gaps is valuable. The prevalence of perinatal Women who gave birth to female infants, in the depression in women with obstetric complications light of China’s one-child policy, were at greater in China is estimated to be 10–15%2 and it is risk for postpartum depression.11 This is in con- reported to be higher in women of the Chinese trast to studies conducted in Western societies, one-child generation compared with previous which did not find an association between fetal generations, particularly among women who gender and postpartum psychology.1 China’s give birth to a daughter.3 Perinatal depression gender preference has become a subject of sub- appears to be more common in rural than in stantial discussion since the implementation of urban areas.4 Prevalence rates are highest in the the one-child policy in 1974. The one-child policy rural areas’ prefecture-level cities (25.4%), lower has been suggested to lead to stronger preference in the provincial capitals (19.5%) and lowest in the for males, and disappointment over the infant’s municipalities directly under central government gender is a significant risk factor for perinatal (12.9%).5 However, epidemiological research depression in China.11 Whether the recently shows that women in metropolitan areas are espe- introduced two-child birth control policy will cially at risk for developing common mental have a positive effect on women’s perinatal mental disorders.6 health remains to be seen. 50 BJPSYCH INTERNATIONAL VOLUME 17 NUMBER 3 AUGUST 2020 Downloaded from https://www.cambridge.org/core. 30 Sep 2021 at 09:45:04, subject to the Cambridge Core terms of use. Women experiencing postpartum depression and the mother–infant relationship, and online report conflicts in attempting to conform to the therapy. Women with major depressive disorder Chinese traditional ideals perceived as necessary (EPDS score >15) or other severe mental disor- to maintain family harmony, while desiring to ders are referred to the Shanghai Mental Health assert modern values such as individuality and Centre or secondary psychiatric hospitals. independence. Living with extended family after Similar services are also provided in several childbirth is commonplace. It involves potential other institutions in China in different provinces. for relationship conflicts, as living with parents- in-law after childbirth has been described as a Mental health resources and service risk factor for perinatal depression among delivery Chinese women.10 Higher prevalence of relation- The World Health Organization’s Mental Health ship conflicts was found in Chinese women with Gap Action Programme (mhGAP) recommends perinatal depression.10 Paternal perceptions of psychological treatment as the first-line manage- partner support and social integration reduce ment for common non-psychotic mental disor- the risk for perinatal depression and are espe- ders.13 However, resources and access to cially important in China, with its specific trad- qualified mental healthcare services are limited itional extended-family dynamics. It has been in China, especially in rural areas.14 The major- reported that good postnatal care and ‘doing ity of mental health professionals in China work the month’ are protective factors against perinatal in specialty psychiatric hospitals and the number depression. Specific components of confinement of trained mental health professionals is inad- practices might reduce psychological distress in equate to meet the patients’ needs and fill the Chinese mothers during the postpartum period, treatment gap. Therefore, developing skilled although the available evidence is inconsistent.10 human resources and enhancing the capacity of primary care services needs to be prioritised China’s maternity healthcare system and for delivering efficient mental healthcare at the perinatal mental health community level. China currently lacks national guidelines on peri- natal mental healthcare and there is no systematic Traditions and societal pressures referral system for perinatal mental disorders,12 In Chinese social settings, postpartum care is although recommendations have been made to influenced by both traditional beliefs and contem- improve mental health in the 2017–2020 national porary healthcare practices.9 ‘Doing the month’ guidelines issued by the Chinese Ministry of after childbirth involves a series of practices Health and the 2030 Agenda for Sustainable related to the maternal role, physical activity Development. Shanghai is an exception, with and a traditional diet, believed to restore maternal perinatal guidelines issued by the Shanghai postpartum physical and mental health.9 Parents Centre for Women’s and Children’s Health in and parents-in-law encourage new mothers to 2017 focusing on maternal mental health and adhere to traditional practices.9 Traditionally, recommendations for perinatal screening for mothers-in-law exercised significant power in mental health disorders.12 However, implementa- Chinese households and had a major influence tion of screening and treatment are yet to be on the postpartum care of their daughters- established. Shanghai Centre for Women’s and in-law.10 In urban China there is an emerging Children’s
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