Department of Psychiatry, National Institute of Mental Health and Neuro Sciences [NIMHANS], Bangalore, 560029, India.
Arch Womens Ment Health. 2018 Oct;21(5):573-578. doi: 10.1007/s00737-018-0830-5. Epub 2018 Mar 21.
Postpartum severe mental illness (SMI) often presents with risks to mother-infant dyad and requires early assessment and interventions. The access to psychiatric care in low and middle income countries is complex. Help-seeking patterns in women with postpartum SMI has not been studied adequately. Hence, the present study was undertaken to examine the help-seeking pattern and reasons for delay in seeking psychiatry services among postpartum women with SMI. Successive patients with a diagnosis of postpartum SMI were recruited over a period of 2 years. Clinical variables including the risk evaluation, perceived delay in seeking care along with the reasons were assessed through clinical interviews using a proforma. Severity of illness was assessed using BPRS and "encounter" form was used to assess the help-seeking pattern. One hundred twenty-three women with postpartum SMI participated in the study. Acute polymorphic psychotic disorder was the most common clinical presentation. Psychiatrists were the most commonly (52.8%) sought care providers followed by faith healers (26%) and general medical practitioners (GMP) (21.1%) at the first level of help seeking. A past history of psychiatric illness was significantly higher among those who first contacted a psychiatrist, and BPRS scores were significantly high among those who contacted a GMP. Forty-four percent of subjects perceived a delay in seeking care from psychiatry services and the most common reason was lack of resources. There is a need to enhance awareness about postpartum SMI in the community. Faith healers need to be sensitized about the associated risks and the need for early referrals. Addressing the barriers to psychiatric care would help in early detection and treatment of postpartum SMI.
产后严重精神疾病（SMI）常伴有母婴双发风险，需要早期评估和干预。在中低收入国家，获得精神卫生服务的机会较为复杂。对于产后 SMI 患者的求诊模式尚未进行充分研究。因此，本研究旨在探讨产后 SMI 患者的求诊模式以及寻求精神科服务时出现延误的原因。在为期 2 年的时间里，连续招募了患有产后 SMI 的患者。通过使用表格进行临床访谈，评估了包括风险评估、寻求护理的感知延迟以及原因在内的临床变量。使用 BPRS 评估疾病严重程度，并使用“就诊”表格评估求诊模式。123 名患有产后 SMI 的女性参与了本研究。急性多形性精神病是最常见的临床表现。在首次寻求帮助时，最常寻求的医疗服务提供者是精神科医生（52.8%），其次是信仰治疗师（26%）和普通内科医生（21.1%）。首次接触精神科医生的患者中，有精神病史的比例明显更高，而首次接触普通内科医生的患者的 BPRS 评分明显更高。44%的患者认为自己在寻求精神科服务方面存在延误，最常见的原因是缺乏资源。需要提高社区对产后 SMI 的认识。需要使信仰治疗师意识到相关风险以及早期转介的必要性。解决精神科医疗服务的障碍将有助于早期发现和治疗产后 SMI。
