WCM-Q research reveals need for better data on perinatal mental illness

Research by Weill Cornell Medicine-Qatar (WCM-Q) has revealed there is a chronic lack of good data about the prevalence of mental illness among pregnant women and new mothers in the Middle East and North Africa (MENA) region.

Researchers in the Institute for Population Health (IPH) at WCM-Q conducted an exhaustive review of existing research on the prevalence of mental illness among new and expectant mothers in the MENA region. They found that studies were generally of poor quality, used a confusing variety of non-standardized screening tools and definitions of mental illness, relied too heavily on self-assessments, and did not clearly define the risk factors associated with mental illness during and after pregnancy, among other deficiencies. 

The research focused on the perinatal period, which begins at the start of pregnancy and ends a year after the birth of the baby. Perinatal mental illness (PMI) can take the form of depression, anxiety and bipolar disorder and is associated with increased risk of self-harm and suicide in mothers. PMI is also associated with higher rates of infant malnutrition and stunted growth, poor adherence to immunization schedules, increased susceptibility to infectious diseases, and poor cognitive, emotional, behavioral and social development of children. 

Dr. Sohaila Cheema, Assistant Dean of the Institute for Population Health, said: “We know from global studies that perinatal mental illness is a major public health issue in the MENA region, but the existing research does not give us a detailed view of the true prevalence or nature of the problem. Our study shows there is an urgent need for high-quality research into this subject to improve our ability to prevent and treat perinatal mental illness in order to safeguard the health of mothers and their children in the long-term.”

Along with Dr. Cheema, the WCM-Q research team comprised Dr. Sathya Doraiswamy, Assistant Director of the Institute for Population Health; Anupama Jithesh, Projects Specialist; Dr. Sonia Chaabane, Projects Specialist; Dr. Amit Abraham, Instructor of Population Sciences and Projects Specialist; and Dr. Karima Chaabna, Instructor of Population Health Sciences/Population Health and Communication Specialist. The study has been published in the International Journal of Environmental Research and Public Health and is titled ‘Perinatal Mental Illness in the Middle East and North Africa Region-A Systematic Overview’.

The WCM-Q researchers examined 79 primary studies and 15 systematic reviews published between 2008 and 2019. The research focused on pregnant and postpartum women up to one year after delivery living in any of the 20 MENA countries of Algeria, Bahrain, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. The studies that were examined fell into two broad categories: those which gathered data via validated diagnostic tools utilized by highly trained psychiatrists and clinical psychologists, and those which used less rigorous screening tools, which often relied upon subjects self-reporting their mental health status. Studies which utilized validated diagnostic tools reported a prevalence of PMI ranging from 5.6 percent in Morocco to 28 percent in Pakistan, while those which used screening tools reported a far wider variance, ranging from 9.2 percent in Sudan to 85.6 percent in the UAE.

The WCM-Q study also examined the risk factors that are associated with perinatal mental illness, such as education level, wealth and social support from spouses, in-laws and other family members.

The study found that the body of research they examined was very heterogenous, with a wide variety of approaches to the study of perinatal mental illness taken by different researchers. The period of time before and after the birth that was studied varied widely, the diagnostic and reporting tools differed in design and quality a great deal, and the way mental illness was defined varied hugely. Furthermore, the risk factors of education, marital and social support, and wealth were quantified in very different ways from study to study and the tools used to capture this information were generally poorly designed.

Dr. Doraiswamy said: “We found very little consistency in the way the data was collected from study to study, making it very hard to draw useful conclusions of the overall prevalence and character of perinatal mental illness across the MENA region. Qatar has taken huge steps in recent years to invest in high-quality mental health services for pregnant women and new mothers. Better quality academic research on the subject would allow Qatar and countries across the region to design, target and deliver mental health services for women with maximum effectiveness.”

Dr. Cheema and Dr. Doraiswamy said that population health campaigns to raise awareness about perinatal mental illness could help prevent the condition by showing spouses and family members how valuable their support can be for new and expectant mothers. They also believe that the establishment of a standardized set of research methodologies for collecting data on perinatal mental illness is required.

Dr. Cheema added: “Having a baby is a unique and special time in a woman’s life but it can be very stressful and challenging. We feel there is a need for better research in the MENA region to help us understand how to provide the best possible care so all women have the maximum chance of having a safe pregnancy and birth and can then enjoy the time they have with their new baby.”