OVERVIEW

• Anxiety and depression are common complications of pregnancy and the postpartum period.• They not only have a significant impact on

maternal wellbeing but also can lead to adverse obstetric, fetal and infant outcomes.• Case-finding and appropriate assessment are

essential. • Women should be referred for appropriate

management.

RISK FACTORS FOR POSTNATAL DEPRESSION

• Past history of depression or anxiety.• Depression and anxiety during pregnancy.• Life events.• Lack of support or perceived lack of support.• Difficult relationship with a partner.

Adverse obstetric outcomes associated with anxiety and depression during pregnancy

• Pre-eclampsia.• Increased nausea and vomiting,

longer work absence during • pregnancy.• Elective Caesarean delivery and

excessive analgesia during labour.• Admission of the infant to

neonatal care.

Story ONE--Sailabala• Sailabala, 40, is due to deliver her sixth child in 2 weeks time. • She couldn’t believe she was pregnant when she found out, • she had thought those days were over and was happy with her independence her part-

time job. • Her husband and his parents were pleased with the news of the pregnancy,• Her children seemed indifferent, • Elina 22, studying in College seems to avoid being with the family. • Lately, Sailabala has felt too tired to do the housework, • She can’t sleep whatever tired she feels. • She hopes she feels different when the baby is born.• Baby was born, underweight, No one to help, lost her wage, • Poverty was her companion, spends sleepless nights, becomes physically weak.• Now she feels the burden, develops PPD

Story TWO - Elina• Elina is 22 and in her final year at university.• Staying with boyfriends in a rented house. • All was going well until her boyfriend decided to leave 4 months ago. • She didn’t tell him she was pregnant. She has managed to cope with her studies with

the support of her friends on her course. • The house owner is very supportive, and have said she can stay, • She feels increasingly isolated from her university friends, and her family, and is

struggling to cope with her situation. • Her parents, who live a good distance away, were shocked that she didn’t consider a

termination.• The events with her mother likely happen to her.

Depression

• Postnatal depression is the most common medical complication of childbirth and follows around 13% of deliveries. • Higher rates are reported in areas with social adversity and

deprivation.

Risk Assessment• Elina, vulnerable to depression following delivery as her partner has

left,• She is feeling isolated from her friends, • Couldn’t terminate pregnancy due to ignorance and lack of access.• Her parents are disapproving of her situation.• Shailibala, in the first case study, feels unsupported by her children,• Continues paid job to maintain family.• Already has some symptoms suggestive of depression,• Which increase her risk after delivery.

Suicide and risk assessment

• Any woman with depressive symptoms should also be asked about thoughts of harming herself or others, • A woman can be actively suicidal or unable to resist thoughts of

harming another person, including her baby, requires urgent psychiatric assessment• Other side • WOMAN PRESENTING WITH ANXIETY ACCOMPANYING SEVERE UPPER BACK

PAIN WAS DIAGNOSED AS SUFFERING FROM POSTNATAL DEPRESSION EVEN WHEN SHE WENT ON TO COMPLAIN OF SHORTNESS OF BREATH, CHEST PAIN AND HAEMOPTYSIS. SHE WAS AGITATED AND FRIGHTENED OF DYING AND LATER DIED OF PULMONARY EMBOLISM

INTERVENTION• Mild disorders can benefit from guided self-help and support • local support groups, or telephone or online support. • Health visitors trained in non-directive counselling or cognitive-behavioural skills

can effectively support.

• Those with moderately severe depression can benefit from psychological therapies such as cognitive- behavioural therapy or interpersonal therapy. This can be delivered on an individual or group basis, and access to such therapies would improve with the introduction of NMHP. • In women with moderate to severe depression and/or

anxiety,antidepressants are indicated.