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 well-being 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 well-being and needs of our mothers,
wives, sisters, and daughters. If anything, we put their emotional well-being in peril – through
our actions or inactions. A good starting point is to be aware of their mental health
What are the commonest emotional problems in women? The reality is that mental health problems affect men and women 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 acyclical 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 is common 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 afterward and then resolve. It is usually mild in some individuals
but may be severe and disabling in others. If symptoms are severe, there may be a need to seek
help to improve functioning. Several people are usually aware of these episodic behavioral
problems if they interact with affected individuals frequently enough…and can readily pinpoint
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: the 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 the
safety of delivery, will the child be normal or abnormal? And so on.
The immediate aftermath of delivery: This period may also have its 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 witchcraft
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 childbirth. 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 that she needs medical
Middle age: Menopause also comes with hormonal changes and some behavioural problems
such as changes 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, 18th May 2023