Maternal Mental Health Day is dedicated to highlighting the unique mental health challenges that women often experience during their reproductive life. Women are often the guardian of the family’s wellbeing and functioning. Indeed, the social fabric of society is usually determined more or less, by the influence of women through child rearing and values that are passed on. But scant attention is paid to the emotional wellbeing and needs of our mothers, wives, sisters and daughters. If anything, we actually put their emotional wellbeing in peril – through our actions or inactions. A good starting point is to be aware of their mental health peculiarities.
What are the commonest emotional problems in women?The reality is that mental health problems affect men and women fairly equally. But some occur more in men while others are more commonly found among women. The commonest conditions affecting women across their lifespan are depression and anxiety disorders. The majority of these gender specific conditions are thought to be mediated by fluctuations in levels of some female hormones which occur in a cyclical manner.
Using a lifespan approach, the following phases of life can be discussed.
Adolescence and early adulthood: Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD). This iscommon among young females and it is a condition characterized by feelings of bloating, fatigue, changes in sleep and eating habits, as well as feelings of irritability, anxiety and sadness. These features usually start about 7 – 10 days before the onset of menses and may persist for a few days afterwards and then resolves. It is usually mild in some individuals but may be quite severe and disabling in some others. If symptoms are severe, there may be a need to seek help – simply to improve functioning. Several people are usually aware about these episodic behavioral problems if they interact with affected individuals frequently enough…and can readily pin-point such episodes.
Pregnancy: Anxiety and depression are also quite common here, usually having a U-shaped frequency of occurrence across the three trimesters of pregnancy. Thus, levels are high during the first trimester, lowest during the mid-trimester and high again in the final trimester just before delivery. These fluctuations follow the expectant mother’s pattern of worry: first trimester – will the pregnancy stay or will I suffer a miscarriage? Hope it is not a false alarm and that I am truly pregnant? And so on. But by mid trimester, these worries are allayed and she is calm. By the final trimester, anxiety and depression again increases, with concerns over safety of delivery, will the child be normal or abnormal? And so on.
Immediate aftermath of delivery: This period may also have it’s own mental health challenges for women. These may include depression (post-partum depression) or psychosis. In post-partum depression, the crash in the level of female hormones (usually produced by the placenta, which has now come out, after delivery of the baby too) is thought to be responsible. It is characterized by excessive moodiness, crying for no specific reason, feeling tired and not being excited while everyone is celebrating the birth of a new child. This may be transient and last only for a few hours or days, in which case, it is normal. However, in some instances, such feelings may persist for weeks and the mother may even begin to question why she brought an innocent child into this miserable and sinful world. She may have suicidal ideas and entertain thoughts of harming the baby and herself. The early warning signs include weepy spells, not being willing to nurse the baby or pay attention to the baby, refusing to eat and neglecting to take care of her personal hygiene. In such instances, coupled with the possibility of harming herself and her baby, immediate attention should be provided and she should see a psychiatrist or mental health professional without delay. In some unfortunate instances, they may actually harm the child and that becomes a tragedy and she may be accused of witch-craft or demonic possession with severe consequences in our communities. This is not right and should be stopped.
Psychosis may also occur in the aftermath of child birth. In this instance, the woman begins to talk and behave abnormally, may hear voices and be restless and agitated. Similarly, it should be clear to close family members that something is wrong and she needs medical attention.
Middle age: Menopause also comes with hormonal changes and some behavioural problems such as change in sleep patterns, irritability and restlessness. These symptoms may be mild and settle after some time, but in other situations, may be so severe as to warrant seeing a mental health professional.
Conclusion: We need to appreciate and understand the emotional challenges as they affect women and be supportive during such episodes. Expert medical attention should be promptly provided when necessary to alleviate the problems.
Dr Jibril Abdulmalik
Tribune Article for the column “Your Mental Health & You”
Thursday, 5th May 2022
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