Mental Health

Dalys most common mental disorder

depression, anxiety, drugs

women metal health 18th century

hysteria attributed to movement of the uterus

Men vs Women

women more likely to have bipolar affective disorder, depression, anxiety, panic, phobias, eating disorders, brain damage from alcohol, mental disorders associated with pregnancy ; men higher rate of alcohol

whats behind gender differences in mental illnesses globally

social status of women, gender-based violence, pregnancy

social status of women

unequal distribution of power, decision making, human rights, reproductive choices, discrimination: preference for male children, worse nutrition and health, less education, forced marriage, child/adolescent marriage, societal expectations: appearance

cultural significance of motherhood

primary source of support, value, and economic security, ofter mistreated and divorced if they become infertile, closely follow the rules of marriage (FGM)

unpaid work and care giving

primary responsibility for unpaid work, precludes income independence, depression and anxiety, greater use of medication, less confident and happy, increased social isolation

health impacts of intimate partner violence

negative physical, sexual, reproductive and mental health consequences for women

gender violence through a women’s life

prenatal: sex selection, infancy: female infanticide, neglect, abuse, differential access to food and medical care, childhood: FGM and sexual abuse, adolescence: dating violence and sexual abuse, Reproductive age: abuse by intimate partners, sexual harassment, rape, old age: anuse of widows, and elder abuse

help seeking

many do not seek help or file reports

help seeking specific to Tanzania

social cultural barriers beginning in the home reduce women seeking help, structural barriers emerge once a survivor has decided to help

maternal and child health in war and disaster situations

80 percent of forced displacement are women and children, exposed to higher risks of sexual violence, exploitation and future stigmatization, destruction of necessities of life and lack of income opportunities, depression, destruction of healthcare infrastructure and services increasing mortality and morbidity

GBV gender based violence, fragility and conflict

fragility and armed conflict increase women’s chances of experiencing GBV including intimate partner violence

mental illness and pregnancy

pre-pregancy mental disorders worsen if medications need to be stopped, post-partum blues, depression and psychosis, loss of pregnancy, obstetric fistulae - depression, suicidal thoughtsisk r

risk factors for mental illness before, during and after pregnancy (biological, psychological, social, cultural)

biological: nutrition status, infections, chronic disease, substance use, problems with pregnancy, psychological: personality and coping skills, past experiences of abuse or neglect, past mental health problems, social: violence, income insecurity, excessive caring burden, insufficient emotional and social support, single mother, lack of family planning options, having a female baby (sometimes), poor in-law relations, cultural - if a woman’s culture usually provides postpartum support but she doesn’t receive it

people with mental health disorders are

less likely to use family planning options, later presentation for prenatal care, at higher risk of poor obstetric outcomes, maternal stress hormones can pass through the placenta and may reduce birth weight

complications after pregnancy

pregnancy loss - anxiety, guilt, major depression, obstetric fistula - can lead to social ostracization, major depression, grief, loss of confidence, suicidal thoughts

mental health disorders cause problems once the child is born

maternal stress hormones that pass through the placenta may be associated with later child behavioral disorders/emotional problems, and cause neglect, harm, and attachment problems for the child, maternal distraction can cause higher levels of child stunting, diarrhea, infections, and missing vaccinations

post-partum challenges to a mother’s mental health challenges

disconnect between theory, expectation and reality, excessive idealized situation, conflicting advice, chronic sleep deficit, feelings out of control/overwhelmed, poor social or marital support

post-partum depression risk factors

birth-related trauma, history of depression, poor social support, poverty, unplanned pregnancy, impact on children: insecure attachment, poor nutrition and attendance to health and care, less likely to be vaccinated

post partum psychosis

psychiatric emergency and hospitalization if risk if suicide, symptoms: mania, depression, confusion, hallucinations, paranoia, delusions, risk factors: bipolar, schizoaffective disorder, schizophrenia, relative with PPP, treatment: medications to control acute psychosis, mood stabilizers, atypical antipsychotics, and antiepileptic drugs

child mental health

few specialists, almost none get help in developing countries, half start before 14

Dalys by age

depressive disorders by far the most

prevalence of mental disorders in children

developmental disorders like autism and anxiety disorders the most

key time for good/bad mental health

infancy, type of attachment to mother predicts future social and emotional development, separation, poor bonding, maltreatment, negative attitudes from mother leads to anxiety and insecurity, post-natal depression/psychosis can harm attachment

future problems with having mental health problems in childhood

problems in school, absence or drop out, suspension or expulsion, lower levels of academic achievement, children in welfare system are less likely to be placed in a permanent home and more likely to be moved around and end up in juvenile detention

risk factors for child mental illness

individual attributes and behaviors, genetic and biological factors (learning disability, low self esteem, prenatal exposure to alcohol or drugs, chromosomal abnormalities, physical illness)

social and economic risk factors for child mental illness

divorced parents, poverty or homelessness, bullying, neglect and family conflict, parental alcoholism

environmental risk factors for child mental illness

minority racism, and gender discrimination, cultural beliefs and practices, access to essential living, health services, and rule of law, exposure to wars and disasters

special risk factors in low-income and unstable settings

conflict - victims of violence and sexual abuse, child solders, watching others being harmed, disasters - PTSD, internal displacement by war and famine - disconnection from families and loss of parental support, disruption of education, illness, poverty, lack of structure and safety - increased depression, phobias, suicide, homelessness - survival tactics including criminal activity, prostitution, gangs, substance abuse, violence

impact of war and conflict

PTSD, psychological disorders, abuse, sexual violence, injury, kidnapping, child soldiers, malnutrition and disease

WHO recommendations of treating mental disorders

integrate mental health into primary health care, provide mental heath care in general hospitals and develop community-based mental health services (talking therapies, occupational therapy, better medications)

SUNDAR

simplify the message, unpack the treatment, deliver whee the people are, affordable and available human resources, reallocation of specialists to train and supervise

delivering mental health care to children in developing countries

little progress integrating into primary pediatric care, current research does not support training primary care workers resulting in long term improvements in treatment for children, most mental illnesses identified and diagnosed by the education system

mhGAP recommendations for developmental disorders (intellectual disability and autism)

psycho-education and parent training, educational support and teacher training, community-based rehabilitation, protecting human rights, support for carers including treating any maternal depression, follow up regularly

mhGAP recommendations for developmental disorders (hyperkinetic disorders/ADHD/oppositional defiant)

family psycho-education, educational support and teacher training, caregiver support, medication under care of specialist only