19th WPA World Congress of Psychiatry

^{9 October 2019}

Social determinants of perinatal mental health problems and how non-health sector policies are influential in reducing them

Professor Jane Fisher discusses how perinatal mental health problems among women are predominantly socially determined and how new evidence from Vietnam shows that legislation to reduce household poverty and making domestic violence a crime have led to a reduction in population level perinatal mental health. This has contributed to a promising new non-medical intervention.

Presenting on the social determinants of perinatal mental health problems at the 19^th World Psychiatry Association’s (WPA) World Congress of Psychiatry, Professor Jane Fisher said that addressing common mental disorders (CMDs) through individual-level interventions will have limited impact because CMDs, particularly in the perinatal and early natal period, are predominantly socially determined. Instead, Prof Fisher said, the focus should be on multi-sectoral public health approaches, leveraging health, social and economic policies to establish better support for pregnant and new mothers.

Held in Lisbon, Portugal, from 21 to 24 August 2019, the four-day conference was chaired by WPA President, Professor Helen Herrman AO. The conference attracted more than 4000 participants from 100+ countries to address mental health as a global concern to which local solutions are needed.

WPA acknowledges importance of perinatal and early natal period

Professors Prabha Chandra from the National institute of Mental Health and Neurosciences, Bengaluru, India, Charlotte Hanlon from the University of Adis Ababa, Ethiopia, Olayinka Omigbodun, from the University of Ibadan in Nigeria, and Jane Fisher were invited to present a Collaborative Interorganizational Symposium with the International Marcé Society for Perinatal Mental Health and the International Association for Women's Mental Health, titled Perinatal care: a top priority for mental health care programs.

The WPA wished to explicitly acknowledge the importance of the perinatal period for the prevention of mental health problems and reduction of intergenerational transfer of poor parenting.

“Perinatal mental health problems are recognised in high-income countries, but there is much less awareness of them in low- and middle-income countries,” Professor Fisher said.

“Yet the reality is that prevalence rates are often higher in low- and middle-income countries and this is a result of disparities in the social circumstances in which women live between nations,” she said.

“Understanding and responding to the social determinants of perinatal mental health problems by looking at structural and intermediary factors outside a woman’s individual control is essential to making services, systems and policies effective,” said Professor Fisher.

Research highlights effectiveness of non-health measures

Jane Fisher’s presentation, Understanding and responding to the social determinants of perinatal mental health problems: essential to making services, systems and policies effective, included new evidence generated by Honours student, Ruby Stocker, who has undertaken secondary analyses of data from collaborative research in Vietnam. It shows that public policies – in this case, laws to make domestic violence a crime and to reduce household poverty – outside the health sector make a measurable impact on maternal mental health.

“Our data shows that social and economic policies can be effective levers in improving population-level health outcomes; in this case perinatal mental health,” said Professor Fisher.

The symposium concluded that much more expert attention needs to be focused on mental health promotion and the prevention of perinatal mental health problems, and that mental health should be measured as a sensitive indicator of policy improvements.

“Global and Women’s Health contributes knowledge to these fields through its research about the social determinants of mental health problems experienced by women across the life course, and community-based interventions, implemented by primary health care workers, to address these,” said Professor Fisher.

Promotion, prevention and treatment

Major keynote presentations by Professor Herrman, who is also Professor of Psychiatry and Director of the WHO Collaborating Centre for Mental Health at the University of Melbourne, and Professor Norman Sartorius, former director of the World Health Organization's Division of Mental Health, and a former president of the World Psychiatric Association Professor reinforced the importance of mental health promotion and the prevention of perinatal mental health problems.

Professor Vikram Patel, Pershing Square Professor of Global Health and Social Medicine at Harvard University demonstrated the multiplicative harms that flow from failing to recognise the inter-relationships between mental health problems and chronic non-communicable diseases. Each emphasised that high income countries can learn from the initiatives in low-income countries which have used task sharing with community-based workers to make effective improvements in mental health.

Identifying the social factors of mental health problems, addressing issues in the context of the life-course, and preventing intergenerational transfer were also strong themes raised. In addition, the building of sentiment towards a bottom-up, rather than top-down approach was noticeable throughout the four-day conference.