Abstract
Introduction: Maternal mental health has a significant impact on the health and well-being of both mothers and their children. Yet despite the prevalence and severity of unmet maternal mental health needs, mental health is often overlooked as a national health priority, and this seems particularly true in low- and middle-income countries (LAMICs).
Main Body: Pregnancy and childbirth provide a unique entry point for evaluation and prevention of mental health problems with women, children, and their families as part of their regular care. In this chapter, we review what is known about maternal mental health in LAMICs and, in particular, in Rwanda.
Discussion: We then review the success of community/peer support (again with an emphasis on LAMICs) as a way to reduce the impact of maternal depression on women and their children, reflect on the meaning of community support and maternal depression for women in Rwanda, and consider Rwandan notions of individual and community resilience.
Implications: Training the community members who ordinarily assist new mothers to detect mental health problems and provide mental health education could improve well-being and facilitate an approach to mental health as a family and community-wide issue.
The research reported here was made possible by funding from Grand Challenges Canada to M. Hynie, Canadian International Development Agency to D. Cechetto, and Social Sciences and Humanities Research Council to S. McGrath.
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References
Amnesty International. (2004). Rwanda: “Marked for death”, rape survivors living with HIV/AIDS. Retrieved from http://www.amnesty.org/en/library/info/AFR47/007/2004
Bennett,G. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics & Gynecology, 103(4), 698–709.
Betancourt, T. S., Meyers-Ohki, S., Stulac, S. N., Barrera, A. E., Mushashi, C., & Beardslee, W. R. (2011). Nothing can defeat combined hands (Abashize hamwe ntakibananira): Protective processes and resilience in Rwandan children and families affected by HIV/AIDS. Social Science & Medicine, 73, 693–701.
Black, M. M., Baqui, A. H., Zaman, K., El Arifeen, & Black, R. E. (2009). Maternal depressive symptoms and infant growth in rural Bangladesh. The American Journal of Clinical Nutrition, 89(3), 9515–9575.
Bolton, P., Neugebauer, R., & Ndogoni, L. (2002). Prevalence of depression in rural Rwanda based on symptom and functional criteria. The Journal of Nervous and Mental Disease, 190(9), 631–637.
Chaskin, R. J. (2008). Resilience, community, and resilient communities: Conditioning contexts and collective action. Child Care in Practice, 14(1), 65–74.
Clarke, K., King, M., & Prost, A. (2013). Psychosocial interventions for perinatal common mental disorders delivered by providers who are not mental health specialists in low- and middle-income countries: A systematic review and meta-analysis. PLoS Medicine, 10(10), e1001541. doi:10.1371/journal.pmed.1001541.
Cohen, S. (2004). Social relationships and health. American Psychologist, 59, 676–730.
Cohen, M. H., Shi, Q., Fabri, M., Mukanyonga, H., Cai, X., Hoover, D. R., Binagwaho, A., & Anastos, K. (2011). Improvement in posttraumatic stress disorder in postconflict Rwandan women. Journal of Women’s Health, 20(9), 1325–1332.
Dennis, C.-L. (2003). Detection, prevention and treatment of postpartum depression. In D. E. Stewart, E. Robertson, C.-L. Dennis, et al. (Eds.), Postpartum depression: Literature review of risk factors and interventions (pp. 79–196). Toronto, ON: University Health Network Women’s Health Program.
Dennis, C.-L. (2014). Psychosocial interventions for the treatment of perinatal depression. Best Practice & Research. Clinical Obstetrics & Gynecology, 28, 97–111.
Dennis, C.-L., & Hodnett, E. D. (2007). Psychosocial and psychological intervention for treating postpartum depression. Cochrane Database of Systematic Reviews, 17(4), CD006116.
Dix, T., & Meunier, L. N. (2009). Depressive symptoms and parenting competence: An analysis of 13 regulatory practices. Developmental Review, 29(1), 45–68.
Draguns, J. G. (2007). Psychotherapeutic and related interventions for a global psychology. In M. J. Stevens & U. P. Gielen (Eds.), Toward a global psychology: Theory, research, intervention, and pedagogy (pp. 233–266). Mahwah, NJ: Lawrence Erlbaum.
Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399–419.
Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1–6.
Fisher, J., de Mello, M. C., Patel, V., Rahman, A., Tran, T., Holton, S., & Holmes, W. (2012). Prevalence and determinants of common perinatal mental disorders in women in low- and middle-income countries: A systematic review. Bulletin of the World Health Organization, 90(2), 139G–149G.
Halbriech, U., & Karkun, S. (2006). Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders, 91(2–3), 97–111.
Handicap International. (2009). Supporting persons living with trauma by rebuilding social and community links. Kigali, Rwanda: Handicap International Rwanda.
Harpham, T., Huttly, S., De Silva, M. J., & Abramsky, T. (2005). Maternal mental health and child nutritional status in four developing countries. Journal of Epidemiology and Community Health, 59, 1060–1064.
Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
Hernández, P. (2002). Resilience in families and communities: Latin American contributions from the psychology of liberation. The Family Journal: Counseling and Therapy for Couples and Families, 10(3), 334–343.
Hynie, M., & Hammer Burns, L. (2006). Cross-cultural issues in infertility counseling. In S. N. Covington & L. Hammer Burns (Eds.), Infertility counseling: A comprehensive handbook for clinicians (pp. 61–82). Cambridge, England: Cambridge University Press.
Hynie, M., Umubyeyi, B., Bohr, Y., Cechetto, D., Gasangawa, M. C., King, R., et al. (2013). A community-based mental health intervention for maternal mental health in Rwanda. Grand Challenges Global Mental Health Seed Grant.
Josefsson, A., & Sydsjö, G. (2007). A follow-up study of postpartum depressed women: Recurrent maternal depressive symptoms and child behavior after four years. Archives of Women’s Mental Health, 10, 141–145.
King, R. U. (2011). A foolish adventure in a country that went mad: The healing of psychosocial trauma in post-genocide Rwanda. Ph.D. dissertation, Faculty of Social Work, University of Toronto.
Kirkland, K. (2013). Effectiveness of home visiting as a strategy for promoting children’s adjustment to school. Zero to Three Journal, 33(3), 31–38.
Lakey, B., & Orehek, E. (2011). Relational regulation theory: A new approach to explain the link between perceived social support and mental health. Psychological Review, 118(3), 482–495.
Landau, J. (2007). Enhancing resilience: Families and communities as agents for change. Family Process, 46(3), 351–365.
Landau, J. (2013). Family and community resilience relative to the experience of mass trauma: Connectedness to family and culture of origin as the core components of healing. In D. S. Becvar (Ed.), Handbook of family resilience (pp. 459–480). New York: Springer.
Levers, L., Kamanzi, D., Mukamana, D., Pells, K., & Bhusumane, D. (2006). Addressing urgent community mental health needs in Rwanda: Culturally sensitive training interventions. Journal of Psychology in Africa, 2, 261–272.
Martín-Baró, I. (1996). In A. Aron & S. Corne (Eds.), Writings for a liberation psychology. Cambridge, England: Harvard University Press.
Masten, A. S., & Obradović, J. (2006). Competence and resilience in development. Annals of the New York Academy of Sciences, 1094, 13–27.
McGrath, S., Dudziak, S., Hahirwa, J. Isaboke, P., Kalinganire, C., Rutikanga, C., et al. (2013). Synthesizing indigenous and international social work theory and practice in Rwanda. Social Sciences and Humanities Research Council of Canada, Partnership Development Grant.
Milgrom, J., & Gemmill, A. W. (2014). Screening for perinatal depression. Best Practice & Research. Clinical Obstetrics & Gynaecology, 28(1), 13–23.
Munyandamutsa, N., Nkubamugisha, P.M., Gex-Fabry, M., & Eytan, A. (2012). Mental and physical health in Rwanda 14 years after genocide. Social Psychiatry and Psychiatric Epidemiology, 47(11), 1753–1761. doi:10.1007/s00127-012-0494-9.
National Institute of Statistics of Rwanda (NISR), Ministry of Finance and Economic Planning (MINECOFIN). (2014). Rwanda fourth population and housing census 2012: Thematic report: Gender. Retrieved from http://statistics.gov.rw/publications/rphc4-thematic-report-gender
National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], & ICF International. (2012). Rwanda Demographic and Health Survey 2010. Calverton, MA: NISR, MOH, and ICF International.
Norris, F. H., Stevens, S. P., Pfefferbaum, B., Wyche, K. F., & Pfefferbaum, R. L. (2008). Community resilience as a metaphor, theory, set of capacities and strategy for disaster readiness. American Journal of Community Psychology, 41, 127–150.
O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379–407. doi:10.1146/annurev-clinpsy-050212-185612.
O’Hara, M. W., & Swain, A. M. (1996). Rates and risks of postpartum depression—A meta-analysis. International Review of Psychiatry, 9, 37–54.
Paschetta, E., Berrisford, G., Coccia, F., Whitmore, J., Wood, A. G., Pretlove, S., et al. (2014). Perinatal psychiatric disorders: An overview. American Journal of Obstetrics and Gynecology, 210(6), 501–509. doi:10.1016/j.ajog.2013.10.009.
Patel, V., Rahman, A., Jacob, K. S., & Hughes, M. (2004). Effect of maternal mental health on infant growth in low income countries: New evidence from South Asia. British Medical Journal, 328, 820–823.
Patel, V., & Saxena, S. (2014). Transforming lives, enhancing communities—Innovations in global mental health. New England Journal of Medicine, 370, 498–501.
Pham, P., Weinstein, H., & Longman, T. (2004). Trauma and PTSD symptoms in Rwanda: Implications for attitudes toward justice and reconciliation. The Journal of the American Medical Association, 292, 602–612.
Rahman, A., Iqbal, Z., Bunn, J., Lovel, H., & Harrington, R. (2004). Impact of maternal depression on infant nutritional status and illness: A cohort study. Archives of General Psychiatry, 61(Sep), 946–952.
Rahman, A., Malik, A., Sikander,S., Roberts, C., & Creed, F. (2008). Cognitive behavior therapy-based intervention by community home visitors for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. Lancet, 372(9642), 902–909.
Richters, A., Rutayisire, T., & Slegh, H. (2013). Sexual transgressions and social disconnection: Healing through community-based sociotherapy in Rwanda. Culture, Health & Sexuality, 15(Suppl. 4), S581–S593. doi:10.1080/13691058.2013.780261.
Sawyer, A., Ayers, S., & Smith, H. (2010). Pre- and postnatal psychological wellbeing in Africa: A systemic review. Journal of Affective Disorders, 123, 17–29.
Somasundaram, D., & Sivayokan, S. (2013). Rebuilding community resilience in a post-war context: Developing insight and recommendations—A qualitative study in Northern Sri Lanka. International Journal of Mental Health Systems, 7(1), 3.
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161.
Tripathy P., Nair, N. Barnett, S., Mahapatra, R., Borghi, J., Rath, S., et al. (2010). Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: A cluster-randomised controlled trial. Lancet, 375(9721), 1182–1192.
Umuziga, M. P. (2014). Assessment of common perinatal mental disorders in a selected district hospital of the Eastern province in Rwanda. Master’s thesis, University of Western Cape, Cape Town, South Africa.
UN Statistics Division. (2014). Demographic yearbook. Retrieved January 7, 2014, from https://unstats.un.org/unsd/demographic/products/dyb/dybcensusdata.htm
UNFPA. (2009). Rwanda overview. UNFPA. Retrieved January 10, 2009, from www.unfpa.org/webdav/site/global/shared/CO_Overviews/Rwanda_b1_9.18.doc
United National Development Programme. (2014). Human development indices: A statistical update 2012.
Wachs, T. D., Black, M. M., & Engle, P. L. (2009). Maternal depression: A global threat to children’s health, development, and behavior and to human rights. Child Development Perspectives, 3(1), 51–59.
Walstrom, P., Operario, D., Zlotnick, C., Mutimura, E., Benekigeri, C., & Cohen, M. H. (2013). “I think my future will be better than my past”: Examining support group influence on the mental health of HIV-infected Rwandan women. Global Public Health, 8, 90–105. doi:10.1080/17441692.2012.699539.
Whiteford, H. A. Degenhardt, L, Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., et al. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. Lancet, 382(9904), 9–15.
World Health Organization. (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF, and UNFPA. Geneva, Switzerland: WHO Press.
World Health Organization. (2013). Mental health action plan 2013–2020. Geneva, Switzerland: WHO Press.
Worthington, R. L., Soth-McNett, A. M., & Moreno, M. V. (2007). Multicultural counseling competencies research: A 20-year content analysis. Journal of Counseling Psychology, 54(4), 351–361. doi:10.1037/0022-0167.54.4.351.
Zraly, M., & Nyirazinyoye, L. (2010). Don’t let the suffering make you fade away: An ethnographic study of resilience among survivors of genocide-rape in southern Rwanda. Social Science & Medicine, 70, 1656–1664.
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After completing my bachelor’s degree in 2005 at National University of Rwanda as clinical psychologist, I started working for a neuropsychiatric hospital since August 2006. I have attended different trainings and short courses in different approaches of psychotherapy and professional counseling, I also attended mutliple workshops and trainings on maternal mental health organized by UR-College of Medicine and Health Sciences (former KHI) and the University of the Western Ontario through the Maternal New born and Child Health project and this has raised my interest and refreshed my knowledge and skills to help new mothers with maternal mental health problems.
Consistent with the findings of this chapter, at my work place patients with maternal mental health problems are not reported as such; they are diagnosed with other different pathologies and perinatal depression seems to be under-diagnosed. When some of these patients are admitted, they are medically treated by a multidisciplinary team (MDT). This MDT meets once or twice a week for a colloquium around patients and can decide to consider psychological follow-up if the biography of the patients requires it.
My response is a poem which presents a case study that reflects the chapter’s presentation of maternal mental health in Rwanda. It describes an out-patient sent to me by her medical doctor, with indication of a need for deep exploration and psychotherapy. She is 28 years old, married, with her first baby boy. I received her 2 months after her delivery with extreme anxiety, and she was sometimes overwhelmed. She could not feed her baby and had a tendency to avoid him. She had many stressful events in her life; she lost her mother at a young age, had only her supportive elder sister and a non-supportive family-in-law. The therapy sessions helped her to stand on her strengths and helped her husband to understand her situation. With a person-centered approach, we worked out her trauma and she got well. At the end of the therapy, the patient returned to her husband and could take care of her child.
Poem to Perinatal Problems
The things are different
From what I expected
It was in a warm will I conceived
At the birth, I am deceived
Yes, in my womb, it was a pleasure
To feel the part of mine
The delivery, ‘caesarean section’
They divided me into parts!
He was crying, I was dying
Ridiculous, they told me,
That family-in-law
At that time, I missed mum
I missed her, to take care of my fear
I missed her to teach me,
How to become a mother.
Slow by slow, I lost my control
Insects went through my skin
I do not know if I was still a human being
I was scared: what to do?
Still now, people do not understand
Even my husband rejects me,
I love my baby and reject him
I run away, so far away
Can I find a help, for that fear of unknown thing?
I perhaps look for a help
But who will understand me
It is hard even for me to know
What I am going through
Please tell me!
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Hynie, M. et al. (2015). Community Resilience and Community Interventions for Post-Natal Depression: Reflecting on Maternal Mental Health in Rwanda. In: Khanlou, N., Pilkington, F. (eds) Women's Mental Health. Advances in Mental Health and Addiction. Springer, Cham. https://doi.org/10.1007/978-3-319-17326-9_23
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DOI: https://doi.org/10.1007/978-3-319-17326-9_23
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