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Archives of Women's Mental Health

, Volume 21, Issue 5, pp 573–578 | Cite as

Help-seeking patterns in women with postpartum severe mental illness: a report from southern India

  • Harish Thippeswamy
  • Geetha Desai
  • Prabha Chandra
Original Article

Abstract

Postpartum severe mental illness (SMI) often presents with risks to mother-infant dyad and requires early assessment and interventions. The access to psychiatric care in low and middle income countries is complex. Help-seeking patterns in women with postpartum SMI has not been studied adequately. Hence, the present study was undertaken to examine the help-seeking pattern and reasons for delay in seeking psychiatry services among postpartum women with SMI. Successive patients with a diagnosis of postpartum SMI were recruited over a period of 2 years. Clinical variables including the risk evaluation, perceived delay in seeking care along with the reasons were assessed through clinical interviews using a proforma. Severity of illness was assessed using BPRS and “encounter” form was used to assess the help-seeking pattern. One hundred twenty-three women with postpartum SMI participated in the study. Acute polymorphic psychotic disorder was the most common clinical presentation. Psychiatrists were the most commonly (52.8%) sought care providers followed by faith healers (26%) and general medical practitioners (GMP) (21.1%) at the first level of help seeking. A past history of psychiatric illness was significantly higher among those who first contacted a psychiatrist, and BPRS scores were significantly high among those who contacted a GMP. Forty-four percent of subjects perceived a delay in seeking care from psychiatry services and the most common reason was lack of resources. There is a need to enhance awareness about postpartum SMI in the community. Faith healers need to be sensitized about the associated risks and the need for early referrals. Addressing the barriers to psychiatric care would help in early detection and treatment of postpartum SMI.

Keywords

Postpartum psychosis Help-seeking Severe mental illness Pathways Faith healing Acute psychosis 

Notes

Funding

This study was funded by the Indian Council of Medical Research (ICMR), New Delhi. Grant No. 21/12/01/09/ HSR.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest..

Ethical approval

This study was approved by the Institute Ethics Committee.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Babu GN, Subbakrishna DK, Chandra PS (2008) Prevalence and correlates of suicidality among Indian women with post-partum psychosis in an inpatient setting. Aust N Z J Psychiatry 42:976–980.  https://doi.org/10.1080/00048670802415384 CrossRefPubMedGoogle Scholar
  2. Brockington IF, Cernik KF, Schofield EM, Downing AR, Francis AF, Keelan C (1981) Puerperal psychosis. Phenomena and diagnosis. Arch Gen Psychiatry 38:829–833.  https://doi.org/10.1001/archpsyc.1981.01780320109013 CrossRefPubMedGoogle Scholar
  3. Chandra PS, Bhargavaraman RP, Raghunandan VNGP, Shaligram D (2006) Delusions related to infant and their association with mother-infant interactions in postpartum psychotic disorders. Arch Womens Ment Health 9:285–288.  https://doi.org/10.1007/s00737-006-0147-7 CrossRefPubMedGoogle Scholar
  4. Currid TJ (2004) Improving perinatal mental health care. Nurs Stand 19:40–43.  https://doi.org/10.7748/ns2004.09.19.3.40.c3702 CrossRefPubMedGoogle Scholar
  5. Dennis CL, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33:323–331.  https://doi.org/10.1111/j.1523-536X.2006.00130.x CrossRefPubMedGoogle Scholar
  6. Gater R, de Almeida e Sousa B, Barrientos G Almeida E. Sousa DB, Barrientos G, Caraveo J, Chandrashekar CR, Dhadphale M, Goldberg D, al Kathiri AH, Mubbashar M, Silhan K, Thong D, Torres-Gonzales F, Sartorius N (1991) The pathways to psychiatric care: a cross-cultural study. Psychol Med 21:761–774. doi:  https://doi.org/10.1017/S003329170002239X
  7. Goodman JH (2009) Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36:60–69.  https://doi.org/10.1111/j.1523-536X.2008.00296.x BIR296 [pii]
  8. Lahariya C, Singhal S, Gupta S, Mishra A (2010) Pathway of care among psychiatric patients attending a mental health institution in Central India. Indian J Psychiatry 52:333–338.  https://doi.org/10.4103/0019-5545.74308 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Madan TN (1969) Who chooses modern medicine and why. Econ Polit Wkly 4:1475–1484.  https://doi.org/10.2307/40737928 Google Scholar
  10. Munk-Olsen T, Pedersen HS, Laursen TM, Fenger-Grøn M, Vedsted P, Vestergaard M (2015) Use of primary health care prior to a postpartum psychiatric episode. Scand J Prim Health Care 33:127–133.  https://doi.org/10.3109/02813432.2015.1041832 CrossRefPubMedPubMedCentralGoogle Scholar
  11. Overall JE, Gorham DR (1962) The brief psychiatric rating scale. Psychol Rep 10:799–812.  https://doi.org/10.2466/pr0.1962.10.3.799 CrossRefGoogle Scholar
  12. Pradhan SC, Singh MM, Singh RA, Das J, Ram D, Patil B, Jain AK, Thomas JK (2001) First care givers of mentally ill patients: a multicenter study. Indian J Med Sci 55:203–208PubMedGoogle Scholar
  13. Raguram R (2002) Traditional community resources for mental health: a report of temple healing from India. BMJ 325:38–40.  https://doi.org/10.1136/bmj.325.7354.38 CrossRefPubMedPubMedCentralGoogle Scholar
  14. Sit D, Rothschild AJ, Wisner KL (2006) A review of postpartum psychosis. J Women’s Health (Larchmt) 15:352–368.  https://doi.org/10.1089/jwh.2006.15.352 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryNational Institute of Mental Health and Neuro Sciences [NIMHANS]BangaloreIndia

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