Mums need improved mental health care in UAE, say doctors

Experts said pregnant women at risk of mental health problems need more psychiatric support.

Dr. Paul Bosio MD FRCOG, Chief Medical Officer of Corniche Hospital. Mona Al Marzooqi / The National

ABU DHABI // Doctors are calling for better care and support for the mental health of new and expectant mothers.

The failure to spot and treat disorders during and after pregnancy can have disastrous effects say experts. They are calling for an organised perinatal psychiatry resource in the UAE.

“The vulnerability of women during pregnancy has long been recognised and gives rise for any underlying or any predisposition to mental health issues to surface,” said Paul Bosio, chief medical officer at Corniche Hospital, Abu Dhabi.

“To be clear, we are not talking about ‘day three blues’ that every mum goes through, three or four days after delivery, when they feel overwhelmed, emotional and tearful.

“That may be considered a normal process,” he said.

“Mental health issues go beyond that. A small select group of women will experience clinical depression, which is like a bottomless pit that has no end in sight.”

At the end of the spectrum, mothers may develop full-blown psychosis and may consider suicide or harming their child, he said. “While this is much rarer it can be devastating for whole families.”

Undiagnosed clinical depression is also closely associated with poor outcomes for the baby, said Dr Bosio.

Maternal depression is linked to lower infant birth weight, higher rates of malnutrition and stunting, higher rates of diarrhoeal disease, infectious illness, and other conditions.

Despite this, mental health was still not high on the agenda.

One in three women in developing countries and one in ten in developed countries have significant mental health problems during pregnancy and after childbirth, according to the World Health Organisation. Suicide is the leading cause of maternal death in developed countries.

While there was a lack of local data there was no reason to suggest the prevalence was not the same in the UAE or even higher, said Dr Bosio.

“And to date we have done very little for them,” he said.

Potential mothers-to-be with new, existing or past mental health problems should be advised on how pregnancy and childbirth can increase the risk of depression, said Dr Veena Luthra, a consultant psychiatrist at the American Centre for Psychiatry and Neurology.

“Women should be involved in discussions of the risk of relapse or worsening of mental health disorders during pregnancy or the postpartum period.”

Conditions that increase the risk include a history of depression, anxiety, psychosis or eating disorders.

Other risk factors include domestic violence and teenage pregnancy, she said.

Despite mental-health disorders being common in women in the antenatal and postnatal period they are frequently undiagnosed and untreated.

“Experts have recommended universal screening for depression during pregnancy and in the postnatal period, and this will help early diagnosis and treatment.

“Also, there is lack of integrated services. The separation of mental health and obstetric services leads to difficulty in accessing mental health services owing to stigma, cost and insurance issues,” said Dr Luthra.

“Without a multidisciplinary model there is poor communication between professionals treating the patient.”

Deema Sihweil, clinical director and psychologist at Dubai’s Carbone Clinic, said there was significant support in the community for pregnant women.

“What is lacking, however, is the awareness that more women experience prenatal and postnatal mental health issues than we think,” she said.

“Prenatal and postnatal mental health issues are a serious public health concern that afflict every pregnant woman to some degree, but women often feel quite isolated and not aware that there is plenty of support.”

More public outreach from medical and mental health professionals could assist in breaking this tendency for pregnant women to become isolated, and help them to seek support, she said. Dr Bashir Salih, chief of obstetric medicine at Corniche Hospital, said a new clinic at the maternity hospital – the biggest of its kind in the UAE – was helping women who were suffering with mental health issues during pregnancy.

Doctors screen pregnant women with a questionnaire, and anyone who raises a red flag is referred to the clinic.

Dr Salih wants to see more hospitals offer the same service. Women are more likely to seek help for mental health issues if services are integrated into prenatal or antenatal care, he said.

“What we have done so far is just a start. We are really looking to expand this service.”

An organised perinatal psychiatry resource was needed across the UAE, he said.