Mental health contributes to the burden of diseases across the globe. Evidence reveals that the mental health conditions are the major cause of patient’s visits to the department emergency of postpartum. Psychosis becomes much highlighted in the postpartum period and the major cause has been attributed to lack of availability and appropriate psychological treatment for women after delivery. The study made us of systematic review for primary data collection, where comprehensive information was obtained to address the topic of discussion. Findings revealed that it is important for clinicians to focus on women who present the first episode of psychosis in the peripartum period. Monitoring the health of women both in the periparum and postpartum is crucial to promote health of women thereby preventing the consequences of postpartum. Therefore, the study concluded that to minimize patient visits to the postpartum emergency department would require delivery of suitable psychological treatments to prevent the devastating consequences of psychosis on women and their child.
Introduction
Mental health is a substantial contributor to the burden of disease worldwide. The conditions are among the most common reasons for patients’ visits in the postpartum emergency department. Current studies reveal that psychiatric conditions are ranked the fifth most reasons for the common urgent presentation of postpartum to the emergency department. Postpartum is a period of high-risk for development of mental challenges as well as their recurrence. Mental illness associated with postpartum is one of the most common childbirth complications, which can have adverse impacts for children and women. Evidence reveals that behavioral and mental disorders among women of reproductive age between 15 and 49, account to about 64 million psychiatric morbidity. In every 1 to 2 per 1000 deliveries, psychosis occurs in the peripartum. The first episode of psychosis in the peripartum period may occur in the case of essential key brief psychotic disorder, bipolar disorder, and depressive disorder (Kast & Agarkar, 2017).
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This paper provides a summary of post-partum psychosis including methods, results, discussion and conclusion.
Methods
The study design included the use of systematic reviews related with post-partum psychosis obtained from peer-reviewed articles. The data of the study was collected through conducting searches on databases of PsycINFO, EMBASE, CiNAHL, and PubMed. The search terms used include psychosis, postpartum, mothers, and pregnancy. The inclusion criteria of study included focusing on articles within 5 years, from 2014 to 2019. In addition, the inclusion criteria involved collection of primary data that are relevant to the topic of mental health conditions in the post-partum period.
Results
The search generated 5000 publications, and only three met the criteria for the study. The three studies reported that the incidences of post-partum psychosis among women ranges from 0.89 to 2.6 in every 1000 women. Another study indicated the prevalence of psychosis to be five women in every 1000. However, calculating the worldwide estimate of post-partum psychosis risk is not possible due to the differing methodologies utilized in the study to identify the case.
The methodology search for this study was imperative for the researcher to consider deriving conclusions for the study. The major strength of the systematic review method is that it is an all-inclusive search strategy with more than 5000 publications evaluated and screened. For primary data collection, the study only focused on peer-reviewed articles in order to adhere to the procedure of systematic reviews.
The findings highlight that postpartum psychosis act as an important first sign of the bipolar disorder. In addition, it is a sign of a high-risk non-pregnancy related episodes of mental health problems in the future. Evidence reveals that the highest risk for the first onset of bipolar disorder as well as recurrent episodes of bipolar disorder tend to occur in the postpartum period ( VanderKruik et al., 2017).
The postpartum psychosis of clinical features include insomnia, disorganized thought processes and behavior, agitation, dysphoric, elated. Commonly, psychotic symptoms include hallucinations, delusions, and mood-incongruent delusions. The symptoms of major depressive episode are common in the peripartum period. In the case of acute psychotic break, postpartum women may experience poor concentration, delusional guilt, changes in psychomotor, and anhedonia ( VanderKruik et al., 2017).
Discussion
The findings revealed that women who lack outpatient physician for mental health are at risk of developing post-partum psychosis. Evidence reveal that 60% of the visits in psychiatric emergency department are because of post-partum psychosis. The reason why 60% of women have visited emergency departments was found to be a resultant of lack of access to mental health care at any point after delivery. Less than 15% of women who visit psychiatric emergency departments do not require admission meaning that if they were provided with suitable management for outpatient care, it would help to minimize the cases of post-partum psychosis. The few 15% of postpartum women include those who receive effective mental health care services and at a timely manner such as sufficient treatment for mental their mental health conditions ( Kast & Agarkar, 2017). Most of the emergency department visits occurred averagely at an estimate of 5 months after delivery. This means it is important for women to seek mental health care between the period of delivery and the presentation to the emergency department. Outpatient services for mental health are more accessible meaning it could have a major positive impact on the psychological health condition of postpartum women. The women accessing psychiatric department in postpartum is an indication for a need for mental health care. Providing the women outpatient care could help avoid many of the visits to the department of postpartum psychiatric emergency.
The findings showed that the strongest risk factor for post-partum psychosis was marginalization. These findings reveal that most visits in the emergency department can be minimized if women could have access to suitable services for mental health. Additionally, it is crucial for future research and interventions to take into consideration factors that hinder access and commitment to postpartum mental health care among women who are marginalized.
The poor uptake of mental healthcare among postpartum women is because of lack of an integrated screening for postpartum depression. The mental health issues in postpartum can occur within the first 6 weeks after delivery and progress throughout the year. Therefore, this means that the average of 5 months presentation of postpartum psychosis could be a reflection of the failure to identify and make referral for new mothers after they stop having regular contact with their perinatal care providers. Moreover, findings revealed that poor access to mental health treatment is another obstacle to psychological care in postpartum. Access to poor psychological treatments may include aspects such as failure to attend appointments for childcare, limited cost and availability, as well as lack of adequate availability of drug for treating anxiety and depression in postpartum women. Depression and anxiety in postpartum are attributed to hesitancy to use medication due to concerns regarding lactation, utilization of doses of medication that are less effective, and the stigma surrounding mental health treatment. In addition, marginalization of women results in maternal deprivation, which is a reflection of the disproportion in the social and financial resources needed for optimal access to mental health services especially those related with financial burden ( Kast & Agarkar, 2017)
Another barrier to mental health care in postpartum includes residential instability including lack of adequate support for single mothers to single mothers to go to doctor’s appointments as well as inadequate awareness of services for new mothers. Furthermore, findings reveal that the obstacles to access mental health services in rural areas poses significant risk to development of postpartum psychosis among women. The barriers to care in rural areas among post-partum women could be associated with lack of specialized services for mental health in rural areas ( VanderKruik et al., 2017).
The findings indicated that the existing potential disparity in accessing psychological treatments for postpartum women could be addressed through making access to mental health care services universal to better serve women within a health care system. Women tend to be more engaged with the health care system around the delivery period both for the health care of the baby and for their own obstetrical care. Therefore, it is important for them to have available access to outpatient healthcare provider for mental health services. Moreover, the findings of the studies suggests the need for better understanding of potential obstacles to the utilization of psychological health car in the period of postpartum. The possible interventions that are crucial in addressing post-partum that needs investigation include expanding the focus of psychological health for the nursing services of public health for ostracized women, targeting mental health services for women in disadvantaged neighborhoods, and screening post-partum women for psychotic problems among women who are marginalized. Having more awareness of and support for the suggested interventions to minimize obstacles to care increases the chance of reducing the burden of crises of postpartum mental health in emergency department (Barkar et al., 2016).
It is important to identify patients presenting first episodes of psychosis in the peripartum period to prevent further development of the disease in the post-partum period. The first episode of peripartum without displaying affective symptoms have been attributed to poor management of remission rat in the treatment of women with psychological challenges during this period. Patients exhibiting symptoms during the peripartum period were found to meet the procedure for major episodes of depression resulting in the identification of the depressive disorder comprising of psychotic features. In most instances, the symptoms of psychosis in the periprtum is often confused with mood disorder diathesis due to the different causes of depressive disorder, which causes most patients to go untreated of the main problem affecting them (Barkar et a;., 2016).
Conclusion
It is evident that clinical attention is required to be given to women presenting the first-episode of psychosis in the peripartum period. It is crucial for healthcare providers to be vigilant in monitoring the health progress of women both in the periparum and in postpartum period to identify and treat the symptoms of psychosis to prevent further detrimental effects on both the mother and the child. Findings reveal that women are not provided with appropriate treatments in the post-partum period that could help in the prevention of potential harmful consequences for both the infant and the mother related with psychosis.
References
Barker, L. C., Kurdyak, P., Fung, K., Matheson, F. I., & Vigod, S. (2016). Postpartum psychiatric emergency visits: a nested case-control study. Archives of women's mental health , 19 (6), 1019-1027.
Kast, K. A., & Agarkar, S. (2017). Case study of first episode schizophrenia in pregnancy and postpartum. Archives of women's mental health , 20 (4), 587-589.
VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L., & Cohen, L. S. (2017). The global prevalence of postpartum psychosis: a systematic review. BMC psychiatry , 17 (1), 272.
