Treatment of mental illness after pregnancy

Background

Mental illness during pregnancy and during the infant period does not differ much from the incidence of mental illness in non-pregnant women at the corresponding age range.

Mental illness can have negative consequences not only for the affected woman but to a great extent also her children and the whole family. Mental illness can affect the most important relationship, the connection / bond between the mother and the child. And this affects the mother's ability to take care of her child, the couple relationship and the quality of life. The ability to interact and care for the child can be of great importance for the child's health and development, as the attachment behavior is shaped by the emotional relationship between child and parent.

In Sweden, about 115,000 children are born per year. Premature birth, low birth weight and neonatal complications are more common in children of mothers with mental illness during pregnancy. Postpartum mental illness can lead to negative consequences for children, who are at increased risk of contracting mental illness later in adolescence or as a young adult.

Common mental illnesses include, but are not limited to, depression and anxiety syndrome. Other less common but more serious conditions are, for example, bipolar disorder and psychotic syndrome. In Sweden, suicide is one of the most common causes of death during pregnancy and the year after the birth of the child (3.7/100,000 births).

Although the data differ, with respect to the duration of the follow-up period, between 3 and 6 percent of women will suffer from an actual depression during pregnancy or in the coming weeks or months after childbirth. If women with mild depressive conditions are included, it is reported that 10–20% of women in the perinatal period are affected. Half of the so-called postpartum depression debuts already during pregnancy. Real depression occurs in 59% of women after childbirth. Various risk factors have been identified, such as hormonal changes, stress, lack of support, somatic illness, previous depression and anxiety.

Post-pregnancy depression can be long-lasting untreated. One-third of women with perinatal depression still have symptoms at the child's one-year day. There are differences both internationally and nationally to the extent that different treatments are given.

Anxiety syndrome during the infant period has a similar prevalence as postpartum depressions with about 8.6%. Co-morbidity with both depression and anxiety syndrome is common, between 40 and 70%.

Bipolar syndrome occurs in approximately 1 to 2% of the population. In the case of rapid and drastic illness in psychosis during the infant period, about 80 percent is related to bipolar syndrome. The risk of both bipolar disorder and postpartum psychosis affects approximately 1 to 2 per 1000 new mothers. Women with known bipolar syndrome are at high risk of relapse in manic psychosis after childbirth, especially if mood stabilizing therapy is terminated during pregnancy. Even after many years of trouble free, the risk is 40% to develop a new depressive forest during pregnancy.

Women with chronic psychotic syndrome have an increased risk of relapsing into a psychotic forest after childbirth, usually three months after childbirth.

Aim

Within the framework of the regulatory letter for 2020 (SB no. S2019 / 05315 / RS, Government Decree 2019-12-19), SBU has decided to start this project with the aim of mapping the scientific state of knowledge regarding methods for treating mental illness after pregnancy.

This is achieved by identifying and reviewing systematic reviews to:

  • identify in which areas there are reliable and compiled scientific knowledge and in which areas such knowledge is lacking;
  • identify the need for more primary studies; and
  • identify if there are parts of systematic reviews that can be used when new surveys are produced.

The areas of knowledge covered by the survey are defined and categorized by a group of experts based on populations, interventions and outcomes. The areas included in the survey as well as the classification are then reconciled with representatives of users and professionals so that it is relevant from a Swedish perspective.

The result of the survey will be a map showing where there are, or are missing, reliable compiled research results (systematic reviews). However, the process for this survey does not include any prioritization of the scientific knowledge gaps identified.

Ongoing Projects

Planned to be published: Quarter 1, 2021
Contact SBU: registrator@sbu.se
Registration no: SBU 2020/73