Breaking the boundaries of depression
A large proportion of pregnant women who access antenatal care in South African clinics and hospitals are depressed which could pose a risk to their unborn babies. However, the Perinatal Mental Health Project in Cape Town, which offers counselling to mothers throughout their pregnancy, is playing a role by tackling depression in the initial stages of the pregnancy.
Most programmes only tackle cases of depression among pregnant women after the birth of the baby, the Perinatal Mental Health Project (PMHP) intervenes during the early stages of pregnancy.
Simone Honikman, director of the Perinatal Mental Health Project said although it was common belief that depression occurred after pregnancy, “depression is often noticeable in the beginning stages of pregnancy. We try to tackle it when it starts.”
She said severe cases of depression could be treated more successfully if detected early.
The Perinatal Mental Health Project (PMHP) is part of the Department of Psychiatry and Mental Health at the University of Cape Town. According to PMHP, South Africa’s postnatal depression (PND) prevalence is 3 times that in developed countries. According to research the rate of antenatal depression in Hlabisa, rural KwaZulu Natal is 41% and the rate of postnatal depression in Khayelitsha is 35%.
For over eight years the PMHP has been screening pregnant women for mental health conditions and offering them counselling to help them with various forms of depression and anxiety related to pregnancy.
About 8000 women have been screened for mental illnesses while up to 1 234 women have been counselled as part of this free service. Up to 107 women received counselling from a psychiatrist.
The PMHP model is one of integration. Mental health care is provided on site together with antenatal care services. This means that the mothers needing help can access this service at the same service point where they receive other health care related to the pregnancy.
When the women arrive for antenatal care in Mowbray Maternity Hospital in Cape Town a nurse gives them two questionnaires. This helps to establish whether the women have any signs of depression or anxiety or whether they have any risk factors for mental illness. After the nurse has read through the form and calculated the score according to the women’s responses, she refers those that display signs of depression to Bronwyn Evans, a clinical psychologist with the PMHP.
Evans explained that some of the signs of depression were easily recognisable among pregnant women including lack of sleep, loss of appetite, crying a lot and feeling ashamed.
Carol* was 27 when she fell pregnant with her son who is now two years old. She phoned her partner and father of their unborn son to share the good news, however, that was the last time she ever spoke to him. He disappeared without a trace never to be heard from again.
“Pregnancy is supposed to be one of the happiest periods of a woman’s life but my pregnancy was a depressing period for me. I cried all the time. I was sad and cried all the time,” she said.
Carol was also extremely worried about how her mother would deal with the news of the pregnancy. ”I was the only girl with two brothers and this put enormous pressure on me to behave well. “
“I told my mother that I was not feeling well and that I would see a doctor. When I found out I was pregnant I was worried because I thought she was not going to accept it. I felt like I had disappointed her a lot because I had fallen pregnant before getting married and that the baby’s father didn’t want anything to do with the child,” said Carol.
Carol’s mother was supportive and welcomed the news. However, Carol still struggled to deal with the fact that her partner had deserted her.
She attended antenatal classes at the Mowbray Maternity Clinic and in her seventh month she realised she was not coping with the pregnancy.
“At the clinic they gave me a form to fill in. I normally would not be honest with my friends when they asked me how I was doing but I decided to be honest on the form. The nurses rated my responses and asked me if I would be willing to see a counsellor. I agreed to see Bronwyn because I wanted to be a good mother to my child,” she said.
In the three counselling sessions that she had with Evans she was able to accept the pregnancy. It also brought her closer to her mother and helped her deal with the anger she felt towards her own father for being absent when she was growing up.
“I was able to make peace with everything that I had been through as a child. This helped me to get ready to be a mother to my child. All I ever wanted was to be a good mother to him,” she said.
Honikman said it was sad that mental health services were not yet incorporated into primary health care. “At the moment mental illness is seen as an isolated and specialized condition that needs to be treated separately. Mental health needs to be treated like any other illness. Primary health care workers are not able to distinguish some of the symptoms and they need to be trained for that,” she said.
Honikman added that committing resources to mental health could help ease the burden of many others illnesses including HIV. She said people with mental illness were for example much more vulnerable to HIV infection and were less likely to adhere to treatment when infected.
*Only first name was used at source’s request