Maternal mental health and wellbeing

The recognition that mental disorders during pregnancy and the postnatal period can have serious consequences for individual women, their partners, babies and other children is evidenced in government policy (Department of Health, 2004), the medical and health literature (Ramchandani et al., 2005) and in the psychological research literature (Goodman & Brumley, 1990; Murray, Fiori‐Cowley, & Cooper, 1996). The substantial impact that mental health problems can have and their contribution to maternal morbidity and even to maternal death, is vividly illustrated in the CEMACH report (2004) ‘Why Mothers Die’. Recognition of women's mental health needs pre‐ and post‐partum has grown and the recent Guideline for health professionals and others working with women during the perinatal period (National Institute for Health and Clinical Excellence, 2007) embodies this in the emphasis placed on women centred care and addressing individual needs and wishes.

Concern about the impact of child–parent relationships has led to a range of studies being carried out with women who have severe mental illness such as those mentioned above by Goodman and Brumley (1990), Murray and colleagues (1996) and Mantymaa, Tamminen, Puura, and Luoma (2006). The paper by Joanna Steadman in this edition of the Journal addresses this issue too. Though a relatively small‐scale study is described, the finding that the presence of maternal mental illness was a significant predictor of maternal sensitivity in interaction accords with the literature. However, the finding that mothers' cognitive abilities in terms of speed of memory processing moderated this effect suggests that maternal cognitive functioning, whether or not it is a function of the condition itself in some way or of medication, should be considered when mother–infant interaction is being evaluated. Further research on a larger scale is clearly needed to confirm these findings.

Women's sense of well‐being, or poor mental health, are among the individual characteristics and differences that they bring with them to their pregnancy, which in turn may be affected by the pregnancy itself. Their mental health can also affect their response and adjustment to pregnancy, childbirth, the partner relationship and parenthood. Many papers on the topic of maternal depression and depressive symptoms have been published in the Journal since its inception and the associated psychological issues and problems that relate to this topic are published by researchers from around the world. In this edition, Kaarina Kemppinen and colleagues describe the issues for public health nurses in identifying the needs of infants and their families where some mother–infant dyads observed seemed to be ‘at risk’. Another paper, by Alissa Haedt, focuses on antenatal depression in pregnant women, dissatisfaction with body shape and attachment to the fetus and suggests that high dissatisfaction with body shape may be a marker for intervention. Prenatal attachment in fathers where the pregnancy had been achieved by in vitro fertilisation is also the subject of a paper in this edition by Anna Hjelmstedt and colleagues, where a range of variables including depression and anxiety were examined. The validation by Kaniz Gaussia of the Edinburgh Postnatal Depression Scale (Cox, Holden, & Sagovsky, 1987) for use with Bangladeshi women is presented as a short report in this edition of the Journal, and is an important development that has the potential to be of value, both in the UK and in Bangladesh itself, where it was tested and where there are similar concerns about women's wellbeing in pregnancy and the postnatal period.

There is a role for researchers and practitioners to be involved in studies that address both practical and theoretical issues in the contexts of screening and detection, assessment, treatment and interventions. Both for screening and assessment and in studies in which interventions are being tested standard psychological measures are a key part of the process. The development and use of these is now an essential element in providing care, measuring treatment effects and in testing behavioural and other interventions. In a recent edition of the Journal, Jenny Ingram and Jenny Taylor described how they developed a needs assessment tool that midwives could use with women in the course of providing antenatal care, to identify those likely to develop postnatal depression (Ingram & Taylor, 2007), using several measures including the Edinburgh Postnatal Depression Scale (Cox et al., 1987).

The continued and growing emphasis on the mental health and wellbeing of mothers and fathers is welcome and researchers from many disciplines working in the field of reproductive and infant psychology are contributing on a broad front to the literature in this area.

Notes

¹Maggie Redshaw undertook this work at the National Perinatal Epidemiology Unit which receives funding from the Department of Health. The views expressed in the editorial are those of the authors and not necessarily those of the Department of Health.