Psychiatric sequelae and mental health aftercare experiences in women who had a life-threatening complication in pregnancy and those with uncomplicated pregnancies : an explorative-descriptive study

Abstract

Introduction Studies in the literature indicate that women are vulnerable to develop psychiatric conditions during the perinatal period. Mental health is a neglected topic and that of women’s mental health to a greater extent, with limited attention paid to these women in the South African public health sector. Furthermore, maternal mortality persists as a major public health problem in developing countries, despite global initiatives and strategies aimed at improving maternal health and decreasing mortality. An improvement in maternal health can ensue if together with a decrease in the number of maternal deaths, a reduction in the complications during pregnancy and the postpartum period occurs. Recognition and treatment of severe complications are important as they can have an adverse effect on women’s health not only from a biological but a psychosocial perspective too. The study set out to determine whether women who experience severe life-threatening stressors during pregnancy are more vulnerable to develop psychiatric complications and what are their lived experiences after discharge from hospital? Methods A mixed-method study conducted at two hospitals in Pretoria, South Africa consisted of two arms, a qualitative and a quantitative arm executed in a parallel convergent manner. Data collection occurred concurrently and merging of the data occurred at the level of interpretation. Two groups of participants namely women who experienced life-threatening complications and those with uneventful pregnancies were selected and interviewed at fourtime intervals namely, shortly after delivery, at six weeks, three months and six months postpartum. The quantitative arm consisted of completion of Level 1, symptom appropriate Level 2 cross-cutting symptoms measures and a WHO Disability Assessment. The qualitative arm consisted of in-depth semi-structured interviews of sixteen participants who were purposefully sampled to obtain maximum variation and richness of information. Results A total of eighty-nine women participated in the study. (Forty-six of whom were women with life-threatening complications and forty-three were women with uneventful pregnancies.) Women with life-threatening complications were more vulnerable to develop psychiatric sequelae and presented with a greater variation in their levels of functioning as compared to women with uneventful pregnancies. Psychiatric sequelae included major depressive disorder, anxiety disorders, somatic symptoms, and cognitive impairments; sleep disturbances, anger, psychotic disorders and substance abuse. Common themes identified from the lived experiences included amongst others, feelings of inadequacy, guilt, loss and disappointment, fear of rejection, abandonment, and infidelity and feelings of anger. Conclusion Women in the present study were not only susceptible to risk that predisposed them to develop postpartum psychiatric complications, but also experienced life-threatening complications. These women displayed resilience in that they were able to adapt despite experiencing severe stressors and adversity. The women displayed acceptance, a will to survive and cope as well as strong belief and unwavering faith in God.