Help-seeking patterns in women with postpartum severe mental illness: a report from southern India
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.
KeywordsPostpartum psychosis Help-seeking Severe mental illness Pathways Faith healing Acute psychosis
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..
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 was obtained from all individual participants included in the study.
- 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
- 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
- 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]