Specialist Perinatal Mental Health Services (SPMHS) are a new development in Ireland. This service evaluation examined the impact of the introduction of a SPMHS multidisciplinary team (MDT) on prescribing practices and treatment pathways in an Irish maternity hospital.

Clinical charts were reviewed to collect data on all referrals, diagnoses, pharmacological and non-pharmacological interventions delivered in a SPMHS over a 3-week period in 2019. The findings were compared to the same 3-week period in 2020 following the expansion of the SPMHS MDT.

In 2019 (n = 32) and 2020 (n = 47), most (75 and 79%, respectively) assessments were antenatal. The proportion of patients prescribed psychotropic medication within the SPMHS was not significantly different from 2019 (31%) to 2020 (23%), though more patients were already prescribed psychotropic medications at the time of referral (22% in 2019 v. 36% in 2020). There was an increase in MDT interventions in 2020 with more input from psychology, clinical nurse specialist (CNS), and social work intervention. Adherence to prescribing standards improved from 2019 to 2020.

Prescribing patterns remained unchanged between 2019 and 2020. Improvement was observed in adherence to prescribing standards and there was increased provision of MDT interventions in 2020. Broader diagnostic categories were also used in 2020, possibly suggesting that the service is now providing more individualized care.

The perinatal period constitutes a unique individual and family experience, involved in multifaceted transformations and adaptations at the physical, psychological, social, and emotional levels. This is the period in women’s life cycle where there is a higher risk for the development of mental illness.

To introduce the perinatal mental health programme of the Hospital do Espírito Santo de Évora. The main objective is to structure an intervention with the woman and her support network to promote healthy parenting.

Implementing secondary and tertiary intervention approaches in a general and public hospital in the Alentejo region of Portugal. The programme is composed of the following components and domains of intervention in the pre-conception, pregnancy, and post-partum periods: individual consultation; brief intervention consultation; mindfulness sessions in the immediate postpartum period; home-based interventions; empowerment interventions for hospital and community healthcare professionals.

It is expected that the project will result in a multidisciplinary approach to perinatal mental health, with significant impact, improved perinatal mental health of the women integrated in the project, as well as improved level of satisfaction in the provision of care in the woman/family.

Considering the prevalence and impact of mental health issues in the perinatal period, it is desirable to structure interventions with a holistic and multidisciplinary approach. Perinatal mental health should be prioritized during the entire process of pregnancy and postnatal period. A network of primary and secondary care systems may allow mitigating and/or overcoming vulnerabilities.

No significant relationships.

Pregnancy loss (PL) – by induced or spontaneous termination of pregnancy – is common, although its consequences on women’s mental health are often neglected in clinical practice.

To understand the existence of psychiatric morbidity in women, associated with PL, as well as related risk factors.

Non-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms ‘pregnancy loss’, ‘psychiatry disorder’, ‘depression’ and ‘anxiety’.

After a PL, anxiety is the most frequent symptomatology in 41% of women. Depression occurs in 22-36% of women in the first two weeks after PL, declining over time. Symptoms compatible with Post Traumatic Stress Disorder (PTSD) are found in 25% of women with PL in the first month. Women who meet criteria for PTSD are more likely to present criteria for Depressive Episode. Substance Use Disorder and Prolonged Grief Disorder are also reported, the latter having, as predictors, previous relational difficulties, poor social support and absence of descendants. Risk factors associated with significant psychopathology within PL are, for example, nulliparity, infertility, previous PL, longer gestation time, lower marital satisfaction, previous psychiatric illness, and history of abuse.

In clinical practice, the risk of psychopathology in women with PL should be considered. This population should be actively questioned about the presence of symptoms, as well as their persistence and impact, requiring timely and appropriate pharmacological and psychotherapeutic intervention. Perinatal Mental Health interventions show important gains in the overall health of women and their offspring.

No significant relationships.

The Portuguese shortest version of the Perinatal Depression Screening Scale/PDSS-7 proved to be valid and reliable, in Portugal and Brazil, but it is essential to analyze its operational characteristics before using it for screening purposes.

To determine PDSS-7 cut-off points and associated conditional probabilities to screen for major depression, according to the DSM-5.

he pregnancy sample was composed of 259 women in the second trimester (Mean gestation weeks=17.83±4.750). The postpartum sample consisted of 241 women assessed between the 2nd-6thmonths postpartum(M=17.99±4.689 weeks postpartum). All women completed the PDSS-7 and were interviewed with the Diagnostic Interview for Psychological Distress(Pereira et al., 2017), a semi-structured clinical interview to assess the most prevalent psychiatric disorders in the perinatal period according to the DSM-5 criteria. MedCalc was used to perform ROC analysis.

During pregnancy, the major depression prevalence was of 4.6%(n=12). The cut-off point that maximizes the Youden Index(J=.98, 95%CI: .97-.99; AUC=.99; se=.004; p<.001) was of 18(95%CI:17-19), which resulted in a sensitivity of 100%(71.5%-100%), a specificity of 97.98%(95.3%-99.3%), a positive predictive value/+PP of 68.8%(48.0%-84.0%) and a negative predictive value/-PP of 100%. In the postpartum, the major depression prevalence was of 10.4%(n=25). The cut-off point(J=.79, 95%CI: .63-.82; AUC=.89; se=.036; p<.001) was of 14(95%CI: 12-16), with a sensitivity of 85.0%(69.3%-93.2%), a specificity of 85.0%(69.3%-93.2%), a +PP of 56.5%(46.1%-67.3%) and a -PP of 97.5%(94.6%-98.8%).

The Portuguese version of PDSS-7 presents good combinations of sensitivity and specificity, being accurate and usable to screen for depression during pregnancy and in the postpartum both in research and primary health care.

No significant relationships.

Few studies have investigated the level of planning of pregnancy among women with mental disorder and associated risk factors.

The purpose of this study was to determine the associated factors to UP and psychopathological consequences.

A cross sectional study was conducted at the Perinatal Mental Health Unit of the Hospital Clínic in Barcelona. The total sample comprised 675 consecutive pregnant women with diagnosis of mental disorder (DSM-IV criteria), seen between January 2006 and December 2018. Clinical, psychometric and socio-demographic variables were collected at the first visit. Pregnancy planning was assessed by a question “Was this pregnancy planned?” with three possible answers: 1) Yes, it was planned and has been well received; 2) No, it was not planned but it has been well received; and 3) No, it was an accident. Response 1 was coded as “planned pregnancy” and responses 2 and 3 as “Unplanned Pregnancy”.

38.4% of the sample had an UP. Younger age, lower levels of education, Latin-American population, multiparity, financials problems and poor relationship with the partner were associated with UP in women with mental disorder. The mean EPDS and STAI scores and the presence of self-harming thoughts were significantly higher in women with UP.

UP was associated with more depressive and anxious symptoms and more self-harming thoughts. It is necessary to promote reproductive health care for women with mental disorders and to take into account their reproductive life plan, especially in those with risk factors described.

No significant relationships.

We have recently validated the Portuguese shortest version of the Perinatal Depression Screening Scale-PDSS-7 (items selected from the PDSS-21; each one representing a dimension evaluated by the PDSS-35), for the assessment of depression severity in pregnancy, both in Portugal and Brazil.

To analyze the validity and reliability of the PDSS-7 Portuguese version to evaluate postpartum women both from Portugal and Brazil.

The Portuguese sample was composed of 304 women between the 2nd-6th postpartum months (Mean=20.09±7.21 weeks postpartum). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 121 women (Mean=10.51±4.53 weeks postpartum). All the participants completed the European/Brazilian Portuguese versions of PDSS-21, which was composed of the same items and included the seven items of PDSS-7. Participants also filled in the validated versions of Perinatal Anxiety Screening Scale and Profile of Mood States.

Confirmatory Factor Analysis revealed that the unidimensional model of PDSS-7 presented acceptable/good fit indexes in both samples (Portuguese/Brazilian: χ2/d.f.=2.6598/1.7897; RMSEA=.0740/.0807, CFI=.8289/.7934, TLI=.7901/.8434, GFI=.9298/.9496; p<.001). The PDSS-7 Cronbach’s alphas were of .841/.856 and all the items contributed to the internal consistency. Pearson correlations with postpartum anxiety (.646/.763) and negative affect (.666/.676) were significantly (p<.01) high. PDSS-7 mean scores were higher in the Brazilian sample (16.06±7.39 versus 11.37±4.37, p<.01).

PDSS-7 presented validity (construct and convergent), reliability and utility in clinical and research settings, including in transcultural studies, in Portugal and Brazil, namely in the postpartum.

No significant relationships.

No significant relationships.

Dual pathology during pregnancy, described as the co-occurrence of substance use and mental health problems, is one of the leading preventable causes of maternal and perinatal mortality and morbidity; however, effective and accessible treatments are lacking.

As part of the WOMAP(Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to evaluate the effectiveness of an e-health-based psychotherapeutic program compared to enhanced usual care.

This effectiveness clinical trial was conducted between 2016-2020 in 5 hospitals in the Madrid (Spain) metropolitan area. 2014 pregnant women under 26 weeks of pregnancy were screened. Eligible participants(n=120) were those who screened positive for co-occurring symptoms (AC-OK screener) and were not receiving specialized behavioral treatment. Participants were assessed in depth at baseline, 2,4,8 and 12 months(PHQ-9;GAD-7;PCL-5;AUDIT;DAST;Fagerström) and randomized to the usual care control group(n=38) or to two groups of a 10-session pregnancy-adapted psychotherapeutic program, one delivered by App/internet(n=41) and one by telephone(n=41). Intent-to-treat analyses assessed effectiveness.

Statistically significant effects of the intervention were found for mental health symptoms in the telephone group as compared to the control and App/internet groups, with an improvement effect starting earlier (2 months) and lasting longer (figures 1-3). Regarding substance use, due to the lack of other substances consumption, only smoking and alcohol cessation rates were analyzed. Patients in the App/internet and telephone groups discontinued significantly more, earlier and for a longer period compared to the control group(figures 4-5).

E-health psychotherapeutic programs could benefit pregnant women with dual disorders. An App/internet implementation could only be useful if focused solely on substances.

No significant relationships.

Today the maternal death of black women is four times than the maternal death of white women. A lot has been written about the physical health of black women during pregnancy and childbirth however the perinatal mental health of this group of women is less well researched. I wanted to investigate if black and ethnic minority women in the UK had the same access to perinatal mental health services.

To explore how the access to perinatal mental health services vary between white British and non-white British women.

A literature review was conducted. Papers were selected based on their focus on perinatal mental health service access and differences in access based on ethnicities. Most research focused on the perinatal mental health service access of white British and non-white British groups of women.

The literature review revealed that black African, Asian and minority white women had significantly lower access to community perinatal mental health services when compared to white British women. It was also found that that black African, Asian and minority White women had a higher percentage of involuntary admissions to psychiatric hospitals when compared to white British women.

The literature would suggest that there is less access to perinatal mental health for non-white British women. This suggested that the disparities that exist within perinatal physical health extend into perinatal maternal health.

No significant relationships.

Perinatal mental health problems, defined as mental health problems occurring from the start of pregnancy to one year after birth, substantially affect women's and children's quality of life in low- and middle-income countries. In South Africa, despite high prevalence and documented negative impacts, most women do not receive any care.

A modelling study examined the costs of perinatal mental health problems, namely depression and anxiety, for a hypothetical cohort of women and their children in South Africa over part of their life course (10 years for women, 40 years for children). In sensitivity analysis, additional impacts of post-traumatic stress disorder (PTSD) and completed suicide were included. Data sources were published findings from cohort studies, as well as epidemiological and economic data from South Africa. Data from international studies were considered where no data from South Africa were available.

Lifetime costs of perinatal depression and anxiety in South Africa amount to USD 2.8 billion per annual cohort of births. If the impacts of PTSD and suicide are included, costs increase to USD 2.9 billion. This includes costs linked to losses in quality of life (USD 1.8 billion), losses in income (USD 1.1 billion) and public sector costs (USD 3.5 million).

Whilst important progress has been made in South Africa with regards to mental health policies and interventions that include assessment and management of perinatal mental health problems, substantial underinvestment prevents progress. Findings from this study strengthen the economic case for investing in perinatal mental health care.

Infant mental health (IMH), an area which focuses on the social and emotional development of infants in the context of the parent-infant relationship, has become an increasingly prominent field of both research and clinical practice worldwide. IMH network groups are initiatives which aim to facilitate continuous learning in the IMH approach, provide an opportunity for case discussion and encourage reflective practice. This study aimed to explore the experiences of staff working within an adult mental health (AMH) service and their participation in a perinatal IMH network group (PIMH-NG).

This study had a qualitative research design and the data were collected using a focus group methodology. Participants were recruited from a PIMH-NG which aimed to provide staff working within an AMH setting with the opportunity for continuous development of IMH knowledge. The data were analysed using thematic analysis.

The data gathered from the focus group indicated that staff participating in a PIMH-NG enhanced their clinical skill, reflective practice and supported the dissemination of IMH knowledge throughout their respective teams. The PIMH-NG facilitated this work by providing the opportunity for continuous learning, reflective group discussion and ongoing peer support.

The findings of this study indicate that incorporating elements of an IMH model into AMH services can be beneficial for staff, service users and overall service delivery and development. These findings may be used to develop the structure and content of future network groups of this nature.

The Unit of Clinical Psychiatry of the University Hospital “Ospedali Riuniti – Ancona”, in collaboration with the Marche Region Health System, is conducting a national observational project entitled “Measures related to the prevention, diagnosis, treatment and assistance of postpartum depressive syndrome”, aiming at promoting women’s Mental Health, particularly in pregnancy and peripartum period.

The primary objective is implementing all measures/interventions needed to promptly screening, early diagnosising, and supporting/caring women with mental health disease during pregnancy and peripartum period. A dedicated training program was performed by our clinical team belonging to the Peripartum Psychiatry Outpatient Service of the Unit of Clinical Psychiatry, at the University Hospital “Ospedali Riuniti”, Ancona, Italy, to a selected audience of Gynecologists/Obstetricians/Nurses/Psychologists/Psychiatrists/GPs and Pediatricians.

The training program is a 2-days residential course, held on 21-22th September, 2020. After the training program, all participants (n= 70) were asked to provide an informed consent and complete an online questionnaire to evaluate knowledge/opinions/experiences and clinical practices in the field of depression in pregnancy and postpartum.

A 40-items questionnaire investigated: a) general attitude in performing screening of depression/anxiety during pregnancy; b) overall knowledge about peripartum depression; c) overall knowledge about management/treatment; d) how physicians manage patients with peripartum depression/anxiety (i.e., how they perform screening/diagnosis/treatment during pregnancy, their levels of knowledge/confidence about psychopharmacology in pregnancy).

The findings of the residential course may allow clinicians to adequately inform and help in drafting a preventive, screening and management program able to assist regional stakeholders in the prevention, diagnosis, treatment and assistance of perinatal depression.

No significant relationships.

Unplanned pregnancies are a significant risk factor in perinatal mental health. They also have the potential to result in adverse health impacts for mother, baby and children into later in life. Women from disadvantaged backgrounds are less likely to access contraception. Women are more likely to on board health advice during pregnancy and post partum period due to high level of surveillance by health professionals.

Our aim was for 90% of patients on Coombe Wood Mother and Baby Unit (MBU) to feel supported to make an informed decision about their contraception by October 2020.

A questionnaire was completed by fifteen inpatients at the Mother and Baby Unit over a 4 month period (April- August 2020) to assess areas around their pregnancy and contraceptives of choice. Contraceptive training was provided by a Sexual Health Specialist to staff across multiple disciplinaries on Coombe Wood MBU. Sexual Health discussion groups were delivered by doctors to inpatients on a monthly basis. A post-intervention questionnaire was given to patients.

•53% of patients reported unplanned pregnancies. •40% of women felt lacking confidence in choosing the right contraceptive •The most frequent question asked during the sexual health groups was regarding hormonal contraceptives impacting on mental health. •By September 100% of patients felt they were able to make an informed decision about their contraception on discharge.

Facilitating women to make informed decisions regarding their contraception empowers them to gain autonomy, reduces the risks of physical and mental illness, improves the quality of life for mothers and babies.

Preeclampsia is a new-onset hypertension with new-onset proteinuria after 20 weeks gestation. Scarce evidence regarding psychiatric effects of preeclampsia is available.

To describe a case of a pregnant 24 year-old patient with a premature cesarean section in context of severe preeclampsia and dissociative symptoms.

Patient referred to a third-level hospital for cesarean section due to a severe preeclampsia at week 32, in whom magnesium sulfate, labetalol perfusion and betamethasone are started. In the puerperium period only labetalol up to 300 mg/6h is maintained.

Due to the appearance of pulsating headache and photophobia, a computerized tomography is conducted, showing bilateral insular and occipital hypodensity related to vasogenic edema. High blood pressure is maintained (177/121 mmHg) despite antihypertensive treatment. A magnetic resonance imaging and an ophthalmologic exam do not show significant abnormalities and blood pressure is stabilized with treatment. However, the patient refers new-onset auditory imperative hallucinations and suicide thoughts, being referred to our Acute Psychiatric Ward for clinical assessment and intervention. Treatment with risperidone 2 mg is started. The day after her admission, she does not refer psychotic symptoms, explaining depersonalization symptoms in the previous 5 days, seeing herself having to choose a knife to commit suicide. After discharge, she maintains reiterative dreams in which she falls down from a building, not presenting dissociative symptoms during the day.

Further evidence regarding psychiatric effects of preeclampsia is needed in order to study the consequences of edema and pharmacological treatment. Blood pressure and psychiatric symptoms monitoring after preeclampsia should also be considered.

No significant relationships.

Perinatal mental health symptoms commonly remain underdiagnosed in maternity care settings in the UK, with the COVID-19 pandemic having further disrupted access to adequate care provision. Digital technologies may offer innovative ways to support the mental health needs of women and partners and assist midwives in recognition of concerns.

We set to investigate the current state of perinatal mental healthcare provision in the UK and the acceptability of a digital mental health assessment.

The study entailed completing an online survey. 829 women, 103 partners, and 90 midwives participated in the study. Quantitative data were explored using descriptive statistics. Open-ended responses regarding the perceived benefits and barriers to using a digital mental health assessment were investigated using thematic analysis. Resultant themes were then mapped onto the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model).

The provision of perinatal mental healthcare support was limited and varied across respondents, particularly throughout the COVID-19 pandemic. There was a strong interest in using a digital mental health assessment placed within maternity healthcare settings to screen, diagnose, and triage concerns (Figure 1). In-person and blended care approaches (i.e., in-person and remote support) were preferred by women and partners in the event of further care being advised (Figure 1). Identified barriers and benefits mainly related to physical opportunity (e.g., accessibility), psychological capability (e.g., cognitive skills) and automatic motivation (e.g., emotions).

This study provides proof-of-concept support for the development of a digital mental health assessment to inform clinical decision-making for perinatal mental health concerns.

NMK has financial interest in Psyomics Ltd., a company developing digital diagnostic devices for neuropsychiatric disorders.