Perinatal Anxiety
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Executive Summary In Canada, 20% of women and 10% of men suffer from perinatal mental illness; rates during the COVID-19 global pandemic have doubled. Unlike the United Kingdom, Australia, and many parts of the United States, Canada does... more
Executive Summary
In Canada, 20% of women and 10% of men suffer from perinatal mental illness; rates during the COVID-19 global pandemic have doubled. Unlike the United Kingdom, Australia, and many parts of the United States, Canada does not have a comprehensive national strategy, mandate, or directive to guide how health care practitioners should assess, diagnosis, treat, or provide follow-up to individuals suffering from perinatal mood and anxiety disorders (PMADs) – a spectrum of mental health disorders that can affect an individual from conception to 12 months after birth. The adverse outcomes, both acute and long-term, of PMADs for parents, their children, and families is well known. Consequences of untreated postpartum mood disturbances can include prolonged maternal depression, paternal depression, partner relationship dissatisfaction and conflict, impaired parental-infant interactions and attachment, risk for impaired cognitive or psychosocial development for the child, and in extreme situations, maternal suicide or infanticide. Programs and policies have not kept up with best practices, research, or the overarching science. Services currently available to those experiencing PMADs in Canada are largely inadequate and issues have been magnified during COVID-19. Addressing the psychosocial needs of families to enhance ongoing mental, maternal/child health disparities is a major public health issue.
For these reasons, we, the Canadian Perinatal Mental Health Collaborative (CPMHC), an advocacy organization, are calling on the federal government to enact a national perinatal mental health strategy that includes mandated universal perinatal mental health screening and timely access to treatment among the recommendations listed in this report. The CPMHC is comprised of two founders, over 40 National Committee members (health care practitioners, researchers, and individuals with lived experience) representing all provinces and territories, and Social Media Ambassadors who disseminate campaigns and messages to the Canadian public.
We formed the CPMHC in 2019 and our work gained momentum in January 2020 with the commencement of the #ThisIsMyStory campaign in conjunction with Bell Let’s Talk Day. Followers were asked to submit personal stories surrounding their struggles with mental illness in the perinatal period. Next on the agenda for the CPMHC was the #NowMoreThanEver campaign for World Maternal Mental Health Day (celebrated the first Wednesday in May each year). Individuals with lived experience, dignitaries, politicians, mayors, celebrities and agencies submitted videos of why they felt a national perinatal mental health strategy was needed now more than ever. A compilation video lives on our website (www.cpmhc.ca). This campaign was followed by the submission of an e-petition to the House of Commons for the creation of a national strategy, sponsored and tabled by MP Heather McPherson of Edmonton-Strathcona.
The CPMHC is persisting with our efforts to co-create a national strategy for perinatal mental health care. With a goal to learn about screening and treatment practices across Canada to identify gaps as well as what’s working in different jurisdictions, the CPMHC created a first-of-its-kind national online survey (reviewed and approved by the Conjoint Faculties Research Ethics Board [CFREB] at the University of Calgary) to understand the state of perinatal mental health care in Canada. Four hundred and thirty-five health care practitioners participated. Top findings and the voices of those surveyed are included throughout this report. Critical findings include:
95.8% of health care practitioners believe that perinatal mental health services are insufficient in Canada.
7
87% of health care practitioners in Canada do not have mandated screening for perinatal mental illness at their workplace.
When people are screened and have symptoms indicative of needing intervention, 27% of health care practitioners indicated that patients were able to access their referral within a month, 31% waited between 1-2 months, while 42% had to wait for >2 months for access.
Perinatal mental health services differ across health regions. More than half of health care practitioners surveyed (57.3%) reported that they have not received specialized training in PMADs or were unsure if they received specialized training.
87% of practitioners believe people from diverse backgrounds encounter barriers to accessing perinatal services. These include language, cultural, and cost barriers.
69% of practitioners reported that COVID-19 has complicated access to care, including reduced in-person visits and overall services.
The survey findings underscore a critical need for a national perinatal mental health strategy to address gaps in screening and treatment and are the basis of recommendations in this report. All recommendations have been structured around four pillars of the socio-ecological health care model:
1. Policy
2. Screening
3. Treatment
4. Follow-up
Health care practitioners should integrate screening for perinatal mental illness into routine practice while structural changes are required to ensure accessible and culturally safe treatment of people experiencing perinatal mental illness across Canada.
The CPMHC is requesting a meeting with Minister of Health, the Honourable Patty Hajdu, to discuss our recommendations and how we can work together to create a national perinatal mental health strategy that leaves no one behind.
Enough talk. It’s time for action!
In Canada, 20% of women and 10% of men suffer from perinatal mental illness; rates during the COVID-19 global pandemic have doubled. Unlike the United Kingdom, Australia, and many parts of the United States, Canada does not have a comprehensive national strategy, mandate, or directive to guide how health care practitioners should assess, diagnosis, treat, or provide follow-up to individuals suffering from perinatal mood and anxiety disorders (PMADs) – a spectrum of mental health disorders that can affect an individual from conception to 12 months after birth. The adverse outcomes, both acute and long-term, of PMADs for parents, their children, and families is well known. Consequences of untreated postpartum mood disturbances can include prolonged maternal depression, paternal depression, partner relationship dissatisfaction and conflict, impaired parental-infant interactions and attachment, risk for impaired cognitive or psychosocial development for the child, and in extreme situations, maternal suicide or infanticide. Programs and policies have not kept up with best practices, research, or the overarching science. Services currently available to those experiencing PMADs in Canada are largely inadequate and issues have been magnified during COVID-19. Addressing the psychosocial needs of families to enhance ongoing mental, maternal/child health disparities is a major public health issue.
For these reasons, we, the Canadian Perinatal Mental Health Collaborative (CPMHC), an advocacy organization, are calling on the federal government to enact a national perinatal mental health strategy that includes mandated universal perinatal mental health screening and timely access to treatment among the recommendations listed in this report. The CPMHC is comprised of two founders, over 40 National Committee members (health care practitioners, researchers, and individuals with lived experience) representing all provinces and territories, and Social Media Ambassadors who disseminate campaigns and messages to the Canadian public.
We formed the CPMHC in 2019 and our work gained momentum in January 2020 with the commencement of the #ThisIsMyStory campaign in conjunction with Bell Let’s Talk Day. Followers were asked to submit personal stories surrounding their struggles with mental illness in the perinatal period. Next on the agenda for the CPMHC was the #NowMoreThanEver campaign for World Maternal Mental Health Day (celebrated the first Wednesday in May each year). Individuals with lived experience, dignitaries, politicians, mayors, celebrities and agencies submitted videos of why they felt a national perinatal mental health strategy was needed now more than ever. A compilation video lives on our website (www.cpmhc.ca). This campaign was followed by the submission of an e-petition to the House of Commons for the creation of a national strategy, sponsored and tabled by MP Heather McPherson of Edmonton-Strathcona.
The CPMHC is persisting with our efforts to co-create a national strategy for perinatal mental health care. With a goal to learn about screening and treatment practices across Canada to identify gaps as well as what’s working in different jurisdictions, the CPMHC created a first-of-its-kind national online survey (reviewed and approved by the Conjoint Faculties Research Ethics Board [CFREB] at the University of Calgary) to understand the state of perinatal mental health care in Canada. Four hundred and thirty-five health care practitioners participated. Top findings and the voices of those surveyed are included throughout this report. Critical findings include:
95.8% of health care practitioners believe that perinatal mental health services are insufficient in Canada.
7
87% of health care practitioners in Canada do not have mandated screening for perinatal mental illness at their workplace.
When people are screened and have symptoms indicative of needing intervention, 27% of health care practitioners indicated that patients were able to access their referral within a month, 31% waited between 1-2 months, while 42% had to wait for >2 months for access.
Perinatal mental health services differ across health regions. More than half of health care practitioners surveyed (57.3%) reported that they have not received specialized training in PMADs or were unsure if they received specialized training.
87% of practitioners believe people from diverse backgrounds encounter barriers to accessing perinatal services. These include language, cultural, and cost barriers.
69% of practitioners reported that COVID-19 has complicated access to care, including reduced in-person visits and overall services.
The survey findings underscore a critical need for a national perinatal mental health strategy to address gaps in screening and treatment and are the basis of recommendations in this report. All recommendations have been structured around four pillars of the socio-ecological health care model:
1. Policy
2. Screening
3. Treatment
4. Follow-up
Health care practitioners should integrate screening for perinatal mental illness into routine practice while structural changes are required to ensure accessible and culturally safe treatment of people experiencing perinatal mental illness across Canada.
The CPMHC is requesting a meeting with Minister of Health, the Honourable Patty Hajdu, to discuss our recommendations and how we can work together to create a national perinatal mental health strategy that leaves no one behind.
Enough talk. It’s time for action!
This study examined the perceptions of Latina women regarding perinatal mental health and its treatment. Ninety-five women completed a 60-item Perinatal Mental Health Questionnaire (PMHQ). Responses to items were compared between women... more
This study examined the perceptions of Latina women regarding perinatal mental health and its treatment. Ninety-five women completed a 60-item Perinatal Mental Health Questionnaire (PMHQ). Responses to items were compared between women who completed the questionnaire in English versus Spanish. In regards to the effects of anxiety or depression on the fetus or breastfeeding infant, both English and Spanish participants expressed concern over potential high levels of harm. Despite this, both groups viewed psychotropic medication during the perinatal period to be unsafe. There was a significant difference when it came to therapy (p<0.001), with those completing Spanish questionnaires finding therapy during pregnancy to be less acceptable. A clear gap existed between the perceived high risks of untreated perinatal depression or anxiety and the low acceptability of mental health services. Understanding these results may lead to increased treatment rates and improve long-term health outcomes for both Latina mothers and their infants.
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