Wednesday, July 15, 2020

How Psychiatrists Can Support Maternal Mental Health During Pandemic

Pregnant and postpartum women are likely to face significant challenges due to COVID-19 that may increase their risk of mental health problems. In an article appearing today in JAMA Psychiatry, several psychiatrists describe strategies for helping both women in treatment for psychiatric disorders and those not in treatment.

“Pregnant and postpartum women, already vulnerable owing to mood and anxiety disorders, have faced intensified harms as public health measures have interfered with crucial psychosocial needs specific to the peripartum period,” wrote Alison Hermann, M.D., Elizabeth M. Fitelson, M.D., and Veerle Bergink, M.D., Ph.D. “Maternal mental health is a bellwether in the COVID-19 pandemic, and we must address it expeditiously. Solutions are required on all levels, and systemwide efforts must be well organized and strategic.”

Obstetric Department infection control procedures for maternity wards—including the use of personal protective equipment, surgical masks during active labor, visitor restrictions, and truncated hospital stays postdelivery—may increase the risk of maternal distress at time of delivery and limit the opportunity to address the needs of women after they have given birth, they wrote. Once discharged from the hospital, these women may face additional challenges, as “many previously reliable interventions for postpartum mood regulation have not been available or are severely compromised.” For example, grandparents and overnight infant caregivers may not be able to provide in-person assistance due to physical distancing practices.

To mitigate these challenges for women who are already in psychiatric treatment, Hermann, Fitelson, and Bergink suggested that psychiatrists and mental health professionals take the following actions:

  • Anticipate and plan for circumstances that might negatively impact these women’s mental health, particularly related to postpartum sleep and separation from personal supports. “Clinicians should discuss with patients and their families a plan for symptom monitoring and pandemic-specific contingency responses, including safety planning that considers temporary relocations for women avoiding crowded urban areas or seeking to co-quarantine with personal supports.”
  • Use virtual health platforms to provide preventive psychotherapies, such as cognitive-behavioral therapy or interpersonal psychotherapy.
  • Continue to encourage use of psychoactive medication during pregnancy and while nursing. “[T]he risk of untreated or undertreated illness must loom larger than in nonpandemic conditions, and the discontinuation of successful medication maintenance treatment is discouraged for most medications. For women taking medication that requires blood monitoring, prescribers need to make extra efforts to coordinate blood draws with other planned in-person medical appointments.”

“It is encouraging that many professional societies and treatment centers are developing written, web-based, or app-based psychoeducational materials, which may be particularly important for women not yet engaged with treatment,” the authors noted. “It is essential that these groups coordinate effectively and streamline these efforts so local health care systems can focus on efficient implementation.”

(Image: iStock/FatCamera)

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