Good morning. Thank you very much.
I'm aware from colleagues that women's mental health encompasses a broad range of conditions that others have already spoken about this week, so in my five minutes I'm going to focus on my own areas of knowledge and expertise. I'm going to discuss with you two key topics in this area: postpartum thoughts of infant-related harm and their relationship with infant safety and mental health, and perinatal anxiety and anxiety-related conditions.
To begin, 99% of new parents report unwanted and intrusive thoughts of one's infant being harmed by accident, and over half of new parents report unwanted intrusive thoughts of harming their infant on purpose. This is not generally known, and understanding of this phenomenon is limited. This lack of knowledge has significant negative consequences for parents and their infants.
We now have superb data showing that, when unwanted and intrusive, thoughts of harming one's infant on purpose are not associated with an increased risk of violence toward the infant. They are, however, associated with significant distress and an increased risk of mental health difficulties, the most common of which are obsessive-compulsive disorder and depression.
Health care providers are understandably concerned when a parent discloses thoughts of harming their infant. However, a lack of knowledge in this area often results in unnecessary referrals to child protective services, monitoring for child abuse and, on occasion, child removal. These actions are necessary when there is a real risk to infant safety. However, when not necessary, these dramatic actions can have devastating consequences for parents and their infants.
In this area, I recommend that we develop and evaluate education for care providers to improve their knowledge and management of these disclosures of harm thoughts; that we seek to understand and mitigate the negative consequences of disclosures of postpartum harm thoughts by parents to care providers, in particular for indigenous parents; that we assess the effectiveness of education regarding postpartum harm thoughts in reducing their mental health consequences; and that we learn more about the experience of postpartum harm thoughts by fathers and parents of other genders.
With respect to anxiety and anxiety-related disorders, there are more than 10 such conditions. They disproportionately affect women, and, as a group, are the most prevalent of all mental health conditions. They are also associated with significant distress, life impairment and increased health care costs.
For convenience, I will refer to anxiety and its related conditions collectively as anxiety disorders.
Of pregnant and postpartum people, 21%, or one in five, suffer from one or more of these disorders. They are of particular importance during the perinatal period, because they also negatively impact infant and fetal development. For our health care system to respond effectively to people suffering from these conditions, we require accurate and effective screening, assessment and treatment.
Outside of reproduction, we have excellent psychosocial and medication treatments. Talk therapy—in particular cognitive behavioural therapy, CBT—is the treatment of choice for many of these conditions. CBT is typically as effective as medication at the conclusion of treatment and superior at follow-up and preventing relapse. However, publicly funded CBT is extremely limited; consequently, frequently only those with third party medical coverage, or the means to pay high out-of-pocket costs, are able to access treatment.
Among perinatal people, there is a high acceptability of screening, and talk therapy is strongly preferred to medication. Pregnant people especially need access to evidence-based talk therapy for their mental health due to concerns about the potential negative impact of psychotropic medications on the developing fetus.
My recommendations in this area are to increase research to identify accurate and reliable screening tools for perinatal anxiety disorders, to assess the impact of mental health screening on mental health outcomes for both perinatal depression and anxiety, to assess the effectiveness of CBT in perinatal populations and to identify low-cost ways of increasing CBT access for perinatal people in particular. Generally, I think increased funding specific to perinatal mental health would be very beneficial.
Thank you very much for your time.