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Mental health refers to a person’s emotional wellness and their ability to enjoy life. It is more than the absence of mental illness. It refers to a person having a sense of purpose and a sense of connectedness to others.
Mental health refers to a person’s emotional wellness and ability to enjoy life.
Mental illness is the opposite of mental health. Mental illness is a psychological or emotional condition which prevents a person from functioning normally, over a period of time.
Mental illness can disrupt a person’s thoughts, emotions or behaviour.
Different types of mental illness are defined by particular combinations of thoughts, emotions and behaviours. When these distressing thoughts, emotions or behaviours are sufficiently severe and cause significant inability to do normal activities or tasks, they can be diagnosed as a mental disorder. Mental illness is a diagnosable condition.
Most people have emotional problems of short duration during times of stress which do not interfere with their daily activities. This would not be regarded as mental illness.
Mental illness is a psychological or emotional condition which prevents a person from functioning normally, over a period of time.
Maternal mental illness is mental illness that occurs during pregnancy or in the first year after childbirth.
Maternal mental illness is a mental illness that occurs during pregnancy or in the first year after childbirth.
No. Mental illness is an abnormal, diagnosable condition. In contrast, mental distress (or psychological distress) is where a person experiences a range of possible symptoms that are troubling, confusing or out of the ordinary. Mental distress may be an appropriate response to a threatening situation. Therefore a person with mental distress usually is not considered ‘ill’ in a medical sense because the distress does not last long enough, and functioning is not affected.
However, mental distress that goes on for a long time may affect a person’s mood and wellbeing and develop into a mental illness.
For example: A mother may be distressed about her baby being in hospital, but she does not necessarily have a mental illness. However, if her mental distress goes on for a long time, it may develop into a mental illness.
Mental distress is when a person experiences a range of possible symptoms that are troubling, confusing or out of the ordinary.
Mental illness can be caused by personal factors and influences by society. There may also be physical causes for mental illness. Examples of a physical cause could be chronic infection or disease, anaemia and thyroid deficiency. HIV infection can affect the brain and lead to mental illness. When there is a physical cause to mental illness there needs to be management of both the underlying disease and of the mental illness.
Family, friends, community and how one is able to live one’s life also influence mental health. These are psychosocial factors that can contribute to mental illness.
In South Africa, mental illness during and after pregnancy is very common. About one third (1 in 3) of poor, pregnant women in South Africa experience depression or anxiety.
In South Africa, one in three pregnant women experience depression or anxiety.
Pregnancy and the postnatal period is a psychologically distressing time for many women, particularly for those living in poverty, or with violence, abuse, HIV/AIDS or an unintended pregnancy. Many women in South Africa live in these circumstances.
In high-income countries, the prevalence of maternal mental illness is around 10 to 15%. It is thought to be higher than this in low and middle income countries.
Depression and anxiety. They are known as common mental disorders (CMDs).
Depression and anxiety are known as common mental disorders.
Suicide is a leading cause of maternal death in developed countries. In most low and middle-income countries (including South Africa), suicide data are not accurately recorded. Yet, if the high rates of maternal depression are considered, coupled with poverty, unemployment and substance use, maternal suicide is likely to be very high in these regions.
Yes. If a woman is depressed during pregnancy, there is a strong chance that she will be depressed after the birth of the baby. Depression after the baby’s birth is known as postnatal depression.
The risk of postnatal depression can usually be identified during pregnancy.
In South Africa, there are currently no formal screening programmes to identify women who are at risk of mental illness or who have mental illness. There are also no dedicated mental health services during pregnancy, labour and a year after delivery.
There are no formal screening programmes for maternal mental illness in South Africa.
Very few management procedures and treatment options exist in the public sector in South Africa for treating maternal mental illness. It is often difficult for health workers to identify women’s psychological problems because of staff shortages, high patient numbers and inadequate staff training in mental health. There are no well-defined referral routes for maternal mental health problems even when they are detected at primary-care level.
Mental illness in pregnant women is associated with:
Children of mothers with mental illness are more likely to:
Mental illness in the mother can negatively affect the infant and child.
Mental illness in parents has a negative effect on the social, emotional, cognitive (mental) and physical development of children. This can have a negative impact on the educational and economic potential of children in a country. Therefore, addressing the mental health needs of mothers has positive implications for the wellbeing of women, their children and families, as well as their wider communities and society.
A risk factor is something that increases the chance of a person developing a particular illness or disease. Therefore, a risk factor will increase the likelihood or chance of suffering from an illness, harm or loss.
The risk factors that increase the chance of maternal mental illness are:
A symptom is something that a patient complains of and may indicate a condition, disease or illness. It is a subjective feeling or a presenting complaint. In contrast to a symptom, a sign is a clinical finding that a doctor or nurse makes when examining a patient. For example: A headache is a symptom but an enlarged liver is a sign.
The ‘baby blues’ is a temporary psychological state. It usually starts on the third day after delivery and is probably linked to hormonal changes. It involves sudden mood swings (feeling very happy, then very sad), crying for no apparent reason, feeling impatient, unusually irritable, restless, anxious, lonely and sad. These symptoms last only a few hours or as long as one to two weeks after delivery, and resolve with compassionate support.
However, if these emotions and feelings continue and become so bad that they interfere with a woman’s daily life, and she has difficulty with carrying out her usual daily tasks, then it is possible that she is suffering from a mental illness. The ‘baby blues’ needs to be monitored carefully as about 20% of women who experience the ‘baby blues’ will progress to having postnatal depression.
It is a condition made up of specific patterns of emotional and behavioural symptoms that can be recognised and diagnosed as a particular condition.
No. Mental illness during and after pregnancy can be classified into two different groups: non-psychotic disorders and psychotic disorders.
A common mental disorder is a condition of the mind that affects the way a person feels, thinks or behaves without causing psychosis (a sense of losing contact with reality). These disorders occur most often and typically refer to ‘mood disorders’ or ‘emotional disorders’, such as depression or anxiety.
This is different from psychotic disorders when the person may imagine that they can see or hear things which are not present (discussed in 1-31).
Depression is characterised by low mood, loss of interest and enjoyment, as well as reduced energy for at least two to four weeks. Other common symptoms of depression include:
In severe cases, depressed people may have symptoms of a psychotic disorder.
Depression in characterised by low mood, loss of interest and enjoyment, as well as reduced energy for at least two to four weeks.
Anxiety is characterised by an abnormal and great sense of uneasiness, worry or fear. Symptoms of anxiety include emotional symptoms such as:
Physical symptoms of anxiety include:
These symptoms are normal if there is a real threat present. However, when someone suffers from these symptoms in response to ordinary events, and the symptoms interfere with daily tasks, then it is known as an anxiety disorder.
An anxiety disorder is present when a person experiences symptoms of anxiety in response to ordinary life events.
Anxiety disorders are a common group of disorders in pregnant or postnatal women. There are different types of anxiety disorders, such as:
Generalised anxiety disorder (GAD) is an anxiety disorder that is characterised by excessive, uncontrollable and often irrational worry about many everyday things. The worry often interferes with daily functioning. People suffering from GAD often anticipate disaster, and are overly concerned about everyday matters such as money, death, family problems, friendship problems, work difficulties or their health. The symptoms must have lasted for at least six months for this disorder to be diagnosed.
Generalised anxiety disorder is characterised by excessive, uncontrollable and often irrational worry about everyday things.
Obsessive–compulsive disorder, or OCD, is one of the more common mental illnesses occurring during the perinatal period. Women already suffering from OCD are likely to experience a worsening of symptoms during pregnancy.
OCD is characterised by obsessive thoughts. In addition, compulsive behaviours are present to relieve the stress associated with the obsessive thoughts. Symptoms can range from mild to severe. Persons with OCD experience ‘obsessive’ or unwanted thoughts that occur repeatedly in their mind. For example, a woman with OCD may have:
The woman experiences the disturbing thoughts again and again. They are unpleasant and they produce high levels of anxiety. These obsessions cause the woman to act out repetitive or compulsive (acting from compulsion, against one’s conscious wishes) behaviours, such as:
Obsessive–compulsive disorder is characterised by obsessive thoughts and compulsive behaviour.
The woman performs these behaviours in the belief that these actions will prevent harm to herself or others, such as her child. These patterns provide relief from anxiety for a little while, but this relief is only temporary. These behaviours then become involuntary and difficult to control. If severe and left untreated, OCD can severely affect a person’s ability to function at work, school or at home. Sometimes, women with OCD can feel ashamed and are then less likely to look for help. It is therefore important to recognise these symptoms early. OCD can be accompanied by depression, eating disorders, substance use, attention deficit disorder, or another anxiety disorder.
Post-traumatic stress disorder (PTSD) develops as a result of a traumatic event such as a sexual or physical attack, the unexpected death of a loved one, an accident, war, torture, or a natural disaster. The traumatic event is usually associated with serious physical, emotional or psychological harm, or the threat of harm.
Women who have experienced rape, sexual or emotional abuse, crime, torture or war, or previous traumatic birth experiences (such as previous emergency Caesarean section or stillbirth) are particularly at risk of developing PTSD during or after pregnancy. Pregnancy can act as a trigger for negative memories of past traumas.
PTSD is a common anxiety disorder where a traumatic event or extreme hardship from the past is repeatedly re-experienced emotionally.
Symptoms of PTSD include:
There are also other physical symptoms, such as:
PTSD in pregnancy can lead to pre-term delivery. It can also occur at the same time as depression, other anxiety disorders, or alcohol or other substance use disorders.
PTSD can occur at the same time as depression, anxiety or other mental health disorders.
Tocophobia is an abnormal and persistent fear of childbirth. It occurs in all cultures and social groups and affects one in seven women. It can be related to previous traumatic birth experiences, sexual abuse or rape, or exaggerated stories of painful labour and birth. Sometimes, it can lead to a frightening or traumatic delivery. In such cases:
Tocophobia is an abnormal and persistent fear of childbirth.
A woman who suffers from bipolar affective disorder experiences extreme mood swings, from depression to mania, with a usual recovery stage between the two states. The onset of manic symptoms can be very slow, and can take several weeks or months before it can be recognised.
Mania refers to an extreme increase in energy and activity. The period during which a person experiences mania is called a manic episode. Common symptoms of mania include:
In some cases there may also be symptoms of a psychotic disorder.
Psychotic disorders are severe mental conditions that cause abnormal thinking and perceptions. People with these psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations:
Other symptoms of psychosis can include:
The psychotic beliefs are very real to a person, and cannot be overcome through reasoning. Also, hallucinations, such as hearing voices, can feel very real and frightening to the person. For example, it is not uncommon for these voices to ‘instruct’ to self-harm or harm others. Remember that a woman who hears voices might look like she is talking to herself, but in fact she is answering the voices.
Psychotic symptoms can also lead to difficulties with social interactions. A person with severe symptoms can also have problems with carrying out daily activities.
Schizophrenia is one type of psychotic disorder. People with bipolar affective disorder may also have psychotic symptoms. Other problems that can cause psychosis include alcohol, illicit drugs, some medications, brain tumours, brain infections and stroke.
Treatment depends on the cause of the psychosis. It might involve medication to control symptoms and counselling therapy. Hospitalisation is an option for serious cases where a person might be dangerous to herself or to others.
Psychotic disorders are relatively rare. Approximately 13% of the general population experience psychotic symptoms.
Psychotic disorders are severe mental conditions that cause abnormal thinking and perceptions, loss of touch with reality, delusions and hallucinations.
Postnatal psychosis is the term used to describe the onset of psychotic symptoms following childbirth. It is the most common psychotic disorder in the time after birth. However, other mental conditions, such as schizophrenia, bipolar affective disorder, or alcohol or substance use disorders, can also lead to psychotic symptoms. The onset (how quickly the symptoms appear) of postnatal psychosis is often sudden, within a week of birth, and can become severe quickly.
Psychotic symptoms in the postnatal period often relate to the circumstances at the time. For example:
Postnatal psychosis can be very sudden and severe. The mother may believe someone is trying to harm her or that her baby is evil.
Some women may try to cope with stress, anxiety or depression by taking alcohol or other types of substances. For this reason, it is common for women who suffer from a mental illness to also present with alcohol and substance use disorders. On the other hand, alcohol and substance use can also lead to the development of a mental disorder or symptoms of mental illness (e.g. depression, hallucinations, memory loss).
Dependence refers to when a person starts using alcohol or substances and develops an uncontrollable need to continue, both physically and psychologically. When a person is dependent and stops drinking alcohol or taking substances, the person shows withdrawal symptoms, such as:
On examination they often have an increased heart rate and blood pressure.
It is commonly accepted by health workers that any use of alcohol or substances during pregnancy is not recommended, in particular for the development of and outcomes for the fetus. However, the use of alcohol or other substances becomes particularly harmful to a woman when:
During pregnancy, it has been shown that women can be particularly motivated to quit or reduce the use of alcohol and substances. This provides health workers a valuable opportunity to intervene at this time. The motivational interviewing technique may be very effective.
The use of alcohol or substances can have negative outcomes for the fetus and cause psychosocial problems for the mother.
Co-morbidity refers to the presence of two or more mental or physical disorders at the same time. Often co-morbid disorders affect each other negatively.
It is possible for a woman to suffer from both depression and another mental disorder at the same time, such as anxiety or alcohol and substance use disorder. In this case, a combination of symptoms from different disorders will be present. All of them must be addressed and treated to improve the woman’s mental health.
A pregnant woman booking at a clinic is crying quietly during the examination. The nurse asks her if she is in pain. The patient says that her body aches all over, she just can’t stop crying and feels unhappy all the time. She says she has been feeling this way for the last month and finds it difficult to get up and dressed in the mornings. The nurse cannot find a physical cause for the pain.
Mental health refers to a person’s emotional wellness and ability to enjoy life. It is more than the absence of a mental disorder. It refers to a person having a sense of purpose and a sense of connectedness to others. This patient does not have good mental health.
Mental illness is a psychological or emotional condition which prevents a person from functioning normally, over a period of time. Mental illness can disrupt a person’s thoughts, emotions or behaviour.
One third of poor, pregnant women in South Africa experience depression or anxiety during or after their pregnancy.
Yes, mental illness could lead to suicide. Maternal mental illness also negatively affects the fetus and child.
She could be suffering from a mental illness such as depression. She is crying, feels unhappy and is not able to function properly. Her body aches, but there does not seem to be a physical cause for this. This has gone on for a long time.
An HIV-positive teenager with an unplanned pregnancy has booked for antenatal care late in her pregnancy. She is withdrawn and barely answers the nurse’s questions. The nurse thinks she is behaving like a typically rude teenager.
Her behaviour could indicate low mood and loss of interest and enjoyment in life. These are symptoms of depression.
She would need to find out about the patient’s mood, functioning and how long she has had the symptoms for.
The most common mental disorders during pregnancy are depression and anxiety.
Common psychological symptoms of anxiety include:
Common physical symptoms of anxiety include:
A mother comes into the clinic with a week-old baby. The baby is sick and has rapid breathing. The mother is told that the baby will need to go to hospital for treatment. The mother starts crying.
No, the situation of the baby needing to go to hospital is distressing for the mother. Mental distress would be appropriate and would not indicate a mental illness.
Mood swings and crying in the week or two after the birth of the baby could be symptoms of the ‘baby blues’.
Distress and crying over a long period of time could indicate a mental disorder.
Common symptoms of depression include:
A pregnant woman comes to the clinic for an antenatal visit. She tells the nurse on duty that she cannot move forward in the queue until the man stops talking to her. She mentions that she has ants crawling under her skin. The nurse cannot hear or see a man talking to her. The nurse notices that the woman’s hands are shaking, she is sweating and on examination her blood pressure is high.
She is out of touch with reality – hearing voices and seeing people who are not there.
Symptoms of two different disorders present at the same time.
Yes, withdrawal from alcohol or substance abuse could lead to hallucinations and psychosis.
When a person is dependent on alcohol or drugs and needs them – both psychologically and physically – then this is a mental disorder.
A young woman seems very distressed during labour. She is agitated, screaming and crying, and will not let the midwife perform an internal examination. A friend, who is with her, tells the midwife that the patient became pregnant because she was raped.
She is agitated, screaming and crying and not wanting the midwife to perform an internal examination.
Post-traumatic stress disorder.
As she was raped, being asked to open her legs for an internal examination may trigger terrible memories of the time when she was raped. She could experience flashbacks of the rape. This may increase her heart rate and make her very tense.
They may have experienced physical violence, torture, rape, witnessed brutality or lost loved ones.