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Year : 2017  |  Volume : 145  |  Issue : 3  |  Page : 267-269

Starting the conversation - Integrating mental health into maternal health care in India

1 Consultant Perinatal Psychiatrist, Fortis La Femme, Bengaluru 560 102, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru 560 102, Karnataka, India

Date of Submission09-Jun-2016
Date of Web Publication27-Jul-2017

Correspondence Address:
Prabha S Chandra
Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru 560 102, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmr.IJMR_910_16

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How to cite this article:
Bagadia A, Chandra PS. Starting the conversation - Integrating mental health into maternal health care in India. Indian J Med Res 2017;145:267-9

How to cite this URL:
Bagadia A, Chandra PS. Starting the conversation - Integrating mental health into maternal health care in India. Indian J Med Res [serial online] 2017 [cited 2020 Sep 29];145:267-9. Available from:

The perinatal period is considered the most vulnerable time in a woman's lifespan for developing mental health problems[1]. This is also the period most suitable for intervention as women are likely to be in regular contact with the health system. Low- and middle- income countries (LAMI) have been found to have a higher prevalence of perinatal mental health problems[2] and higher rates of maternal suicide often driven by external factors such as marital conflict and interpersonal violence[3],[4].

There is sufficient evidence to show that postpartum depression is a strong predictor of parenting stress, negatively impacting mother-infant bonding[5] and leading to cognitive, emotional and behavioural problems in children[6],[7]. However, less well known is the impact of antenatal depression and anxiety, which can lead to adverse obstetric outcomes such as placental insufficiency, preterm labour and low birth weight[8]. Antenatal mental health problems are also associated with poor nutrition, inadequate weight gain and irregular antenatal appointments[9],[10]. Children of mothers who have depression or anxiety are more susceptible to attention deficit hyperactivity disorder (ADHD), conduct disorders and emotional problems[11]. Infants of mothers with depression in LAMI countries have high rates of malnutrition, diarrhoea, infections, hospital admissions, and incomplete immunization schedules[3],[12].

With this available evidence, many high- income countries such as the UK, Australia, Norway and the US, have integrated early identification and treatment of perinatal depression into standard healthcare protocols[13],[14],[15]. Addressing maternal mental health will be a major step to ensuring healthy babies and decreasing maternal morbidity. However, there are a few challenges to the introduction of routine maternal mental health screening in India. The first will be the lack of awareness of its importance among obstetricians and other healthcare workers involved in antenatal and postnatal care. In the face of more pressing problems such as anaemia and poor access to hospital deliveries, mental health may not get the priority that it warrants. The second challenge is to find a suitable tool that can work in different settings and with mothers with varying literacy levels.

Translated versions of the Edinburgh Postnatal Depression Scale (EPDS) which is the most widely used scale, have their limitations when used in non-western settings[16],[17] and a simpler tool that can be used by all health workers needs to be considered, which can also help with easy triaging.

The final challenge is to develop access pathways using a stepped-care approach. Different models need to be developed that take into account the pockets of resource intensive sectors amidst vast areas of limited resources. Several solutions are possible to meet these challenges. Upskilling existing community healthcare workers has been tried successfully in South Asian settings[18],[19],[20] which could be a starting point for establishing primary care. Existing counsellors and psychologists could be identified as points of referral for secondary care[21]. Sensitizing obstetricians and paediatricians will ensure that women do not get missed during the antenatal and postnatal periods while a mental health specialist in a district or general hospital could be identified as a point of referral for women with serious mental illness for intensive care[22]. With the strengthening of the District Mental Health Programme, such a care pathway is possible. This will also ensure continuity in delivery of services.

In India, the effective use of technology to educate health workers and primary care doctors in mental health has been met with success[23]. Such a model can be easily implemented to support and guide primary healthcare staff in screening, early interventions and referrals. Such integration will also help in decreasing the stigma related to mental health and viewing it as yet another component of holistic health care.

It is time to start the conversation on maternal mental health and adopt some of the good practices being followed in other countries. Addressing mental health in the perinatal period provides a great opportunity for early intervention not only for the mother and infant, but also for adolescent and adult mental health and behaviour, which eventually affects the entire society.

Conflicts of Interest: None.

   References Top

Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord 2016; 191 : 62-77.  Back to cited text no. 1
Supraja TA, Thennarasu K, Satyanarayana VA, Seena TK, Desai G, Jangam KV, et al. Suicidality in early pregnancy among antepartum mothers in urban India. Arch Womens Ment Health 2016; 19 : 1101-8.  Back to cited text no. 2
Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: A systematic review. Bull World Health Organ 2012; 90 : 139G-49G.  Back to cited text no. 3
Varma D, Chandra PS, Thomas T, Carey MP. Intimate partner violence and sexual coercion among pregnant women in India: Relationship with depression and post-traumatic stress disorder. J Affect Disord 2007; 102 : 227-35.  Back to cited text no. 4
Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 2008; 8 : 24.  Back to cited text no. 5
Parsons CE, Young KS, Rochat TJ, Kringelbach ML, Stein A. Postnatal depression and its effects on child development: A review of evidence from low- and middle-income countries. Br Med Bull 2012; 101 : 57-79.  Back to cited text no. 6
Satyanarayana VA, Lukose A, Srinivasan K. Maternal mental health in pregnancy and child behavior. Indian J Psychiatry 2011; 53 : 351-61.  Back to cited text no. 7
Hoirisch-Clapauch S, Brenner B, Nardi AE. Adverse obstetric and neonatal outcomes in women with mental disorders. Thromb Res 2015; 135 (Suppl 1) : S60-3.  Back to cited text no. 8
Kim HG, Mandell M, Crandall C, Kuskowski MA, Dieperink B, Buchberger RL. Antenatal psychiatric illness and adequacy of prenatal care in an ethnically diverse inner-city obstetric population. Arch Womens Ment Health 2006; 9 : 103-7.  Back to cited text no. 9
Marcus SM. Depression during pregnancy: Rates, risks and consequences – Motherisk update 2008. Can J Clin Pharmacol 2009; 16 : e15-22.  Back to cited text no. 10
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384 : 1800-19.  Back to cited text no. 11
Black MM, Baqui AH, Zaman K, McNary SW, Le K, Arifeen SE, et al. Depressive symptoms among rural Bangladeshi mothers: Implications for infant development. J Child Psychol Psychiatry 2007; 48 : 764-72.  Back to cited text no. 12
Laios L, Rio I, Judd F. Improving maternal perinatal mental health: Integrated care for all women versus screening for depression. Australas Psychiatry 2013; 21 : 171-5.  Back to cited text no. 13
Meltzer-Brody S. New insights into perinatal depression: Pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci 2011; 13 : 89-100.  Back to cited text no. 14
Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA 2016; 315 : 380-7.  Back to cited text no. 15
Austin MP; Marcé Society Position Statement Advisory Committee. Marcé International Society position statement on psychosocial assessment and depression screening in perinatal women. Best Pract Res Clin Obstet Gynaecol 2014; 28 : 179-87.  Back to cited text no. 16
Tran TD, Tran T, La B, Lee D, Rosenthal D, Fisher J. Screening for perinatal common mental disorders in women in the North of Vietnam: A comparison of three psychometric instruments. J Affect Disord 2011; 133 : 281-93.  Back to cited text no. 17
Mendenhall E, De Silva MJ, Hanlon C, Petersen I, Shidhaye R, Jordans M, et al. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Soc Sci Med 2014; 118 : 33-42.  Back to cited text no. 18
Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. Lancet 2008; 372 : 902-9.  Back to cited text no. 19
Tripathy P, Nair N, Barnett S, Mahapatra R, Borghi J, Rath S, et al. Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: A cluster-randomised controlled trial. Lancet 2010; 375 : 1182-92.  Back to cited text no. 20
Honikman S, van Heyningen T, Field S, Baron E, Tomlinson M. Stepped care for maternal mental health: A case study of the perinatal mental health project in South Africa. PLoS Med 2012; 9 : e1001222.  Back to cited text no. 21
Chandra PS, Desai G, Reddy D, Thippeswamy H, Saraf G. The establishment of a mother-baby inpatient psychiatry unit in India: Adaptation of a Western model to meet local cultural and resource needs. Indian J Psychiatry 2015; 57 : 290-4.  Back to cited text no. 22
Thara R, John S, Rao K. Telepsychiatry in Chennai, India: The SCARF experience. Behav Sci Law 2008; 26 : 315-22.  Back to cited text no. 23


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