Ebru FINDIKLI

Perinatal Dönemde Ruh Sağlığı Sorunları, Yaygınlığı, Neden ve Sonuçları: Derleme

Özet Perinatal mental hastalıklar gebelik sırasında ve doğumdan bir yıl kadar sonraki süreçte görülen ruhsal hastalıklardır. Major depresyon, anksiyete bozuklukları, bipolar bozukluklar ve psikoz gibi geniş spektruma sahip bu hastalıkların sıklıkla erken postnatal dönemde tekrarladığı görülmektedir. Altta yatan psikopatolojiler tam olarak aydınlanmasa da gebelik dönemindeki hormonlar, çevresel faktörler, kadının sosyal anlamda desteklenmemesi ve önceki hastalık öyküleri yanı sıra genetik faktörler ve tüm bunların beyindeki nörotransmitter seviyeleri üzerine olan etkileri gibi çok yönlü, çok faktörlü nedenler suçlanmaktadır. Klinik olarak, doğum öncesi depresyona ve anksiyete bozukluklarına maruz kalma çocuklarda bilişsel ve davranışsal sorunlar, dikkat eksikliği/hiperaktivite bozukluğu, otizm, erken ve orta çocukluk dönemlerinde duygusal problemler ile ilişkili bulunmuştur. Perinatal dönemde ortaya çıkan mental hastalıkların tedavisi, farmakolojik, psikoterapotik ve psikososyal alanları içermelidir. Anne sağlığı, çocuk sağlığı ve gelişimi ve nihayet sağlıklı ailelerin hedeflendiği, kar zarar dengesi gözetilerek bireye yönelik müdaheleler planlanıp uzun vadede ciddiyetle uygulanmalıdır. Perinatal mental hastalıkların erken teşhis ve etkili yönetimi kadınlar ve çocuklarının yaşam kalitesi ve refahı açısından kritik öneme sahiptir.

Anahtar Kelimeler:

Anksiyete, Depresyon, Gebelik, Mental, Perinatal

Perinatal Mental Health, Mental Disorders, Frequencies, Causes and Results: Review

Abstract Perinatal mental illnesses occur during pregnancy and up to one year after birth. It is observed that diseases with a wide spectrum such a major depression, anxiety disorders, bipolar disorders and psychosis that are frequently recur in the early postnatal period. Although the underlying psychopathologies are not fully elucidated, multifaceted, multifactorial causes such as hormones during pregnancy, environmental factors, social support of women and previous disease history, as well as genetic factors and the effects of all these on neurotransmitter levels in the brain are blamed. Clinically, exposure to prenatal depression and anxiety disorders has been associated with cognitive and behavioural problems in children, attention deficit/hyperactivity disorder, autism and emotional problems in early and middle childhood. Interventions for the treatment of mental illnesses that occur in the perinatal period are in the form of pharmacological, psychotherapeutic and psychosocial interventions. These aimed maternal and child health, development and finally healthy families should be planned and applied seriously in the long term by considering the benefit risk balance. Early detection and effective management of perinatal mental illnesses are critical for the quality of life and welfare of women and their children.

Keywords:

Anxiety, Depression, Mental, Perinatal, Pregnancy,

PDF

___

Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 2014;384(9956):1789-1799.
Kendell R, Chalmers J, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry 1987;150(5):662-673.
Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am. J. Psychiatry 2016;173(2):117-127.
Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet 2014;384(9956):1775-1788.
Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA 2006;296(21):2582-2589.
Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013;70(5):490-498.
Fisher J, Mello MCd, 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;90:139-149.
Dennis C-L, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 2017;210(5):315-323.
Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J. Clin. Psychiatry 2019;80(4):1181.
Micali N, Treasure J, Simonoff E. Eating disorders symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity. J. Psychosom. Res 2007;63(3):297- 303.
Stevens AW, Goossens PJ, Knoppert-van der Klein EA, Draisma S, Honig A, Kupka RW. Risk of recurrence of mood disorders during pregnancy and the impact of medication: A systematic review. J. Affect. Disord 2019;249:96-103.
Taylor CL, Broadbent M, Khondoker M, Stewart RJ, Howard LM. Predictors of severe relapse in pregnant women with psychotic or bipolar disorders. J. Psychiatr. Res 2018;104:100-107.
Abel KM, Hope H, Swift E, Parisi R, Ashcroft DM, Kosidou K, et al. Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: A national retrospective cohort analysis. Lancet Public Health 2019;4(6):291-300.
McManus S, Gunnell D, Cooper C, Bebbington PE, Howard LM, Brugha T, et al. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. Lancet Psychiatry 2019;6(7):573-581.
Pearson RM, Carnegie RE, Cree C, Rollings C, Rena-Jones L, Evans J et al. Prevalence of prenatal depression symptoms among 2 generations of pregnant mothers: the Avon longitudinal studyof parents and children. JAMA network open. 2018;1(3):180725- 180725.
Popova S, Lange S, Probst C, Gmel G, Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: A systematic review and meta-analysis. Lancet Glob. Health 2017;5(3):290-299.
Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R et al. Saving Lives, Improving Mothers’ Care-Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014- 16:2018.
Wisner KL, Perel JM, Peindl KS, Hanusa BH, Findling RL, Rapport D. Prevention of recurrent postpartum depression: a randomized clinical trial. J. Clin. Psychiatry 2001;62(2):82-86.
Wisner KL, Moses-Kolko EL, Sit DK. Postpartum depression: a disorder in search of a definition. Arch Womens Ment Health 2010;13(1):37-40.
Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology of postpartum depression. Compr Psychiatry 2003;44(3):234- 246.
Bloch M, Rubinow DR, Schmidt PJ, Lotsikas A, Chrousos GP, Cizza G. Cortisol response to ovine corticotropin-releasing hormone in a model of pregnancy and parturition in euthymic women with and without a history of postpartum depression. J. Clin. Endocrinol. Metab 2005;90(2):695-699.
Treloar SA, Martin N, Bucholz K, Madden P, Heath A. Genetic influences on post-natal depressive symptoms: findings from an Australian twin sample. Psychol Med 1999;29(3):645-654.
Tarantino LM, Sullivan PF, Meltzer-Brody S. Using animal models to disentangle the role of genetic, epigenetic, and environmental influences on behavioral outcomes associated with maternal anxiety and depression. Front. Psychiatry 2011;2:44.
Wisner KL, Perel JM, Peindl KS, Hanusa BH, Piontek CM, Findling RL. Prevention of postpartum depression: a pilot randomized clinical trial. Am. J. Psychiatry 2004;161(7):1290-1292.
Dennis C-L. Psychosocial and psychological interventions for prevention of postnatal depression: Systematic review. Bmj 2005;331(7507):15.
Clatworthy J. The effectiveness of antenatal interventions to prevent postnatal depression in high-risk women. J. Affect. Disord 2012;137(1-3):25-34.
Jones I, Craddock N. Searching for the puerperal trigger: Molecular genetic studies of bipolar affective puerperal psychosis. Psychopharmacol. Bull 2007;40(2):115.
Jones I, Hamshere M, Nangle J-M, Bennett P, Green E, Heron J et al. Bipolar affective puerperal psychosis: genome-wide significant evidence for linkage to chromosome 16. Am. J. Psychiatry 2007;164(7):1099-1104.
Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch. Gen. Psychiatry 2012;69(4):428-434.
Munk-Olsen T, Laursen TM, Mendelson T, Pedersen CB, Mors O, Mortensen PB. Risks and predictors of readmission for a mental disorder during the postpartum period. Arch. Gen. Psychiatry 2009;66(2):189-195.
Chaudron LH, Pies RW. The relationship between postpartum psychosis and bipolar disorder: a review. J. Clin. Psychiatry 2003;64(11):17310.
Spinelli MG. Postpartum psychosis: detection of risk and management. Am. J. Psychiatry 2009;166(4):405-408.
Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. Am. J. Psychiatry 2012;169(6):609-615.
Galbally M, Roberts M, Buist A, Perinatal Psychotropic Review G. Mood stabilizers in pregnancy: a systematic review. Aust N Z J Psychiatry. 2010;44(11):967-977.
Vulink NC, Denys D, Bus L, Westenberg HG. Female hormones affect symptom severity in obsessive–compulsive disorder. Int Clin Psychopharmacol 2006;21(3):171-175.
Challacombe FL, Salkovskis PM. Intensive cognitive-behavioural treatment for women with postnatal obsessive-compulsive disorder: a consecutive case series. Behav. Res. Ther 2011;49(6- 7):422-426.
Misri S, Milis L. Obsessive-compulsive disorder in the postpartum: open-label trial of quetiapine augmentation. J. Clin. Psychopharmacol 2004;24(6):624-627.
Misri S, Abizadeh J, Sanders S, Swift E. Perinatal generalized anxiety disorder: assessment and treatment. J. Women’s Health 2015;24(9):762-770.
Wenzel A, Stuart SC. Anxiety in childbearing women: Diagnosis and treatment: APA; 2011.
O’Hara MW, Schlechte JA, Lewis DA, Wright EJ. Prospective study of postpartum blues: biologic and psychosocial factors. Arch. Gen. Psychiatry 1991;48(9):801-806.
Oakley A, Chamberlain G. Medical and social factors in postpartum depression. Obstet. Gynecol 1981;1(3):182-187.
O’Hara MW. Postpartum depression. Postpartum depression. Springer; 1995.136-167.
Buttner MM, O’Hara MW, Watson D. The structure of women’s mood in the early postpartum. Assessment. 2012;19(2):247-256.
Gonidakis F, Rabavilas A, Varsou E, Kreatsas G, Christodoulou G. Maternity blues in Athens, Greece: A study during the first 3 days after delivery. J. Affect. Disord 2007;99(1-3):107-115.
O’hara MW, Swain AM. Rates and risk of postpartum depression— a meta-analysis. Int. Rev. Psychiatry 1996;8(1):37-54.
O’hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu. Rev. Clin. Psychol 2013;9:379-407.
Beck CT. Predictors of postpartum depression: an update. Nurs. Res 2001;50(5):275-285.
Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen. Hosp. Psychiatry 2004;26(4):289-295.
O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract. Res. Clin. Obstet. Gynaecol 2014;28(1):3-12.
Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am. J. Psychiatry 2000;157(6):924-930.
Sacher J, Wilson AA, Houle S, Rusjan P, Hassan S, Bloomfield PM et al. Elevated brain monoamine oxidase A binding in the early postpartum period. Arch. Gen. Psychiatry 2010;67(5):468- 474.
Grigoriadis S, Wilton AS, Kurdyak PA, Rhodes AE, VonderPorten EH, Levitt A et al. Perinatal suicide in Ontario, Canada: A 15-year population-based study. Cmaj. 2017;189(34):1085-1092.
Fuhr DC, Calvert C, Ronsmans C, Chandra PS, Sikander S, De Silva MJ et al. Contribution of suicide and injuries to pregnancy- related mortality in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Psychiatry 2014;1(3):213-225.
Organization WH. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD-MM: WHO;2012.
Johannsen BMW, Larsen JT, Laursen TM, Bergink V, Meltzer- Brody S, Munk-Olsen T. All-cause mortality in women with severe postpartum psychiatric disorders. Am. J. Psychiatry 2016;173(6):635-642.
Khalifeh H, Hunt IM, Appleby L, Howard LM. Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. Lancet Psychiatry 2016;3(3):233-242.
Mitchell J, Goodman J. Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: A systematic review. Arch Womens Ment Health 2018;21(5):505-516.
Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry 2016;73(8):826-837.
Glover V. Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. Perinatal programming of neurodevelopment: Springer; 2015.269-283.
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, Mc- Callum M et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014;384(9956):1800-1819.
Suri R, Lin AS, Cohen LS, Altshuler LL. Acute and long-term behavioral outcome of infants and children exposed in utero to either maternal depression or antidepressants: a review of the literature. J. Clin. Psychiatry 2014;75(10):371.
Rees S, Channon S, Waters CS. The impact of maternal prenatal and postnatal anxiety on children’s emotional problems: a systematic review. Eur. Child Adolesc. Psychiatry 2019;28(2):257- 280.
Conroy S, Pariante CM, Marks MN, Davies HA, Farrelly S, Schacht R et al. Maternal psychopathology and infant development at 18 months: the impact of maternal personality disorder and depression. J. Am. Acad. Child Adolesc. Psychiatry 2012;51(1):51- 61.
Cook N, Ayers S, Horsch A. Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review. J. Affect. Disord 2018;225:18-31.
Micali N, Stahl D, Treasure J, Simonoff E. Childhood psychopathology in children of women with eating disorders: understanding risk mechanisms. J. Child Psychol. Psychiatry 2014;55(2):124-134.
Barker ED, Copeland W, Maughan B, Jaffee SR, Uher R. Relative impact of maternal depression and associated risk factors on offspring psychopathology. Br J Psychiatry 2012;200(2):124-129.
Jacques N, de Mola CL, Joseph G, Mesenburg MA, da Silveira MF. Prenatal and postnatal maternal depression and infant hospitalization and mortality in the first year of life: a systematic review and meta-analysis. J. Affect. Disord 2019;243:201-208.
Waqas A, Elhady M, Dila KS, Kaboub F, Nhien C, Al-Husseini M et al. Association between maternal depression and risk of infant diarrhea: a systematic review and meta-analysis. Public Health 2018;159:78-88.
Reading R. Maternal depression increases infant risk of diarrhoeal illness: a cohort study. Wiley Online Library; 2007.
Dennis CL, Hodnett ED. Psychosocial and psychological interventions for treating postpartum depression. Cochrane database of systematic reviews. Cochrane Database Syst Rev.2007;(4):CD006116.
Camacho EM, Shields GE. Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review. BMJ Open 2018;8(8):e022022.
O’Mahen HA, Woodford J, McGinley J, Warren FC, Richards DA, Lynch TR et al. Internet-based behavioral activation—Treatment for postnatal depression (Netmums): A randomized controlled trial. J. Affect. Disord 2013;150(3):814-822.
Milgrom J, Danaher BG, Gemmill AW, Holt C, Holt CJ, Seeley JR et al. Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J. Med. Internet Res 2016;18(3):e4993.
Milgrom J, Holt C, Holt CJ, Ross J, Ericksen J, Gemmill AW. Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up. Arch Womens Ment Health 2015;18(5):717-730.
Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA 2015;314(17):1818-1830.
Jack RH, Hollis C, Coupland C, Morriss R, Knaggs RD, Cipriani A, et al. Trends in antidepressant prescriptions in children and young people in England, 1998–2017: protocol of a cohort study using linked primary care and secondary care datasets. Evid Based Ment Health 2019;22(3):129-133.
Heinonen E, Szymanska-von Schultz B, Kaldo V, Nasiell J, Andersson E, Bergmark M et al. MAGDALENA: study protocol of a randomised, placebo-controlled trial on cognitive development at 2 years of age in children exposed to SSRI in utero. BMJ Open 2018;8(8):e023281.
Petersen I, Gilbert RE, Evans SJ, Man S-L, Nazareth I. Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from The Health Improvement Network. J. Clin. Psychiatry 2011;72(7):15209.
Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006;295(5):499-507.
Yonkers KA, Gotman N, Smith MV, Forray A, Belanger K, Brunetto WL, et al. Does antidepressant use attenuate the risk of a major depressive episode in pregnancy? Epidemiology (Cambridge, Mass.) 2011;22(6):848.
Taylor CL, Stewart RJ, Howard LM. Relapse in the first three months postpartum in women with history of serious mental illness. Schizophr. Res 2019;204:46-54.
National Institute for Health and Care Excellence: Guidelines. Antenatal and postnatal mental health: clinical management and service guidance. London: National Institute for Health and Care Excellence (NICE) Copyright © NICE 2019;2014.
McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J. Psychopharmacol 2017;31(5):519-552.
Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry 2020;19(3):313-327.