A research by Weill Cornell Medicine-Qatar (WCM-Q) revealed that there is chronic lack of good data about the prevalence of mental illness among pregnant women and new mothers in the Middle East and North Africa (MENA) region.
Researchers from the Institute for Population Health (IPH) at WCM-Q conducted an exhaustive review of existing studies on the prevalence of mental illness among new and expectant mothers in the MENA region. They found that studies were generally of poor quality, used a confusing variety of non-standardised screening tools and definitions, relied heavily on self-assessments, and did not clearly define the risk factors associated with mental illness during and after pregnancy.
The research focused on the perinatal period, which begins at the start of pregnancy and ends a year after the birth of the baby. Perinatal mental illness (PMI) can take the form of depression, anxiety and bipolar disorder and is associated with increased risk of self-harm and suicide in mothers. PMI is also associated with higher rates of infant malnutrition and stunted growth, poor adherence to immunisation schedules, increased susceptibility to infectious diseases, and poor cognitive, emotional, behavioural and social development of children.
Dr Sohaila Cheema, Assistant Dean of the Institute for Population Health, said their study shows an urgent need for high-quality research into the subject to improve the ability to prevent and treat perinatal mental illness in order to safeguard the health of mothers and their children in the long-term.
The WCM-Q research team included Dr Sathya Doraiswamy, Assistant Director of the Institute for Population Health; Anupama Jithesh, Projects Specialist; Dr Sonia Chaabane, Projects Specialist; Dr Amit Abraham, Instructor of Population Sciences and Projects Specialist; and Dr Karima Chaabna, Instructor of Population Health Sciences/Population Health and Communication Specialist.
Perinatal Mental Illness in MENA Region – A Systematic Overview
The study, titled ‘Perinatal Mental Illness in the Middle East and North Africa Region – A Systematic Overview’ has been published in the International Journal of Environmental Research and Public Health.
The researchers examined 79 primary studies and 15 systematic reviews published between 2008 and 2019, focused on pregnant and post-partum women up to one year after delivery and living in these MENA countries: Algeria, Bahrain, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen.
The studies fell into two broad categories: those which gathered data via validated diagnostic tools utilised by highly trained psychiatrists and clinical psychologists; and those which used less rigorous screening tools and relied on subjects self-reporting their mental health status.
Studies which utilised validated diagnostic tools reported a prevalence of PMI ranging from 5.6% in Morocco to 28% in Pakistan. Those which used screening tools reported a far wider variance, ranging from 9.2% in Sudan to 85.6% in the UAE.
The WCM-Q study also examined the risk factors associated with perinatal mental illness, such as education level, wealth and social support from spouses, in-laws and other family members.
The study found that the body of research examined was very heterogenous, with a wide variety of approaches taken by different researchers. The period of time before and after the birth also varied widely, the diagnostic and reporting tools differed in design and quality, and the way mental illness was defined varied hugely. Furthermore, the risk factors of education, marital and social support, and wealth were quantified in very different ways from study to study and the tools used to capture this information were generally poorly designed.
Dr Doraiswamy said they found very little consistency in the way the data was collected from study to study, making it very hard to draw useful conclusions.
Qatar has taken huge steps in recent years to invest in high-quality mental health services for pregnant women and new mothers. Better quality academic research on the subject would allow Qatar and countries across the region to design, target and deliver mental health services for women with maximum effectiveness.
According to Dr Cheema and Dr Doraiswamy, population health campaigns to raise awareness about perinatal mental illness could help prevent the condition, showing spouses and family members how valuable their support can be for new and expectant mothers. They also believe in the establishment of a standardised set of research methodologies for collecting data.
Having a baby is a unique and special time in a woman’s life but it can be very stressful and challenging.
Dr Cheema pointed out the need for better research in the MENA region to help them understand how to provide the best possible care so that all women have the maximum chance of having a safe pregnancy and birth, and can fully enjoy their time with the new baby.