Third instalment of Women’s Winter Webinars series focuses on maternal mental health with Action on Postpartum Psychosis

Posted March 25th 2024

This month, the National Centre for Mental Health hosted the third installment of our Women’s Winter Webinars series, focused on understanding postpartum psychosis.

Leading this session was Professor Arianna Di Florio, joined by Cardiff University researcher Jessica Yang and NCMH Director Professor Ian Jones, as well as Dr Sally Wilson from Action on Postpartum Psychosis (APP).

Over fifty attendees joined the webinar to hear from panellists on the latest in postpartum psychosis, including an interesting question and answer session.

Defining postpartum psychosis

Professor Di Florio began by providing some brief context as to how postpartum psychosis is understood in clinical terms, which at present has not been defined in diagnostic manuals used by psychiatrists.

“This [lack of clarity] hinders research as well as clinical treatment as we don’t know what exactly what we’re dealing with.”

What has been identified in postpartum psychosis research so far is a specific relationship between bipolar disorder and childbirth.

However, Professor Di Florio continued that the boundaries between diagnoses in psychiatry are often blurred and that psychosis is a symptom of many different psychiatric disorders, not just postpartum psychosis.

“If postpartum psychosis is to be included as a separate classification, we need to establish some biology to ground them as such.”

To try to disentangle the relationship between bipolar disorder and postpartum psychosis, Professor Di Florio and her team of researchers at Cardiff University used an existing data set from the Bipolar Disorder Research Network (BDRN) to run a genetic study comparing postpartum psychosis in women with bipolar versus. women who have no previous history of mental illness.

Whilst postpartum psychosis is still a rare occurrence in the general population, affecting less than 1% of women, women who already have a diagnosis of bipolar disorder are more at risk of experiencing postpartum psychosis, equating to around 20%.

Professor Di Florio shared more results of this study using the largest data set of postpartum psychosis from the BDRN.

Watch the webinar

Addressing the gaps in postpartum psychosis knowledge and support

Dr Sally Wilson, the National Training Coordinator for APP, shared findings from the various research studies undertaken by the charity in recent years which has identified a need for more evidence-based information about postpartum psychosis and more recovery support.

Dr Wilson said: “Our work has focused on understanding the experiences of postpartum psychosis and what the information and support needs are for people and families going through this.”

Through this research, APP has written several information guides developed with clinicians and has developed support guides for partners and grandparents who have also been affected by postpartum psychosis.

“One third of women said that they might not be here today without APP’s support.”

Postpartum psychosis in diverse communities

APP have also identified barriers in accessible care for postpartum psychosis in women from Black and Asian communities, where stigma and cultural pressures were cited as barriers to sufficient care.

These findings have led to the establishment of the APP Diverse Communities Outreach project which includes peer support groups for Muslim women and further training for health professionals.

Dr Wilson continued to share more results from APP’s research which also highlighted further insight into recovery and the improvement of care provided.

Postpartum psychosis across the cultures around the world

Jessica Yang, a Researcher at the Centre for Neuropsychiatric Genetics and Genomics at Cardiff University presented the findings from a public involvement consortium looking into postpartum psychosis in the UK, Malawi, and India.

“Most of what we do know about postpartum psychosis is from evidence gathered in Western societies, despite postpartum psychosis impacting women all over the world,” she said.

Working with the International Postpartum Psychosis Consortium, Cardiff University researchers have worked with colleagues in Malawi and India to run discussion groups which include people with lived experience, family and friends, and healthcare professionals.

These discussions have allowed researchers to explore how postpartum psychosis is viewed and approached across cultures by identifying how different presentations and labels are used to describe an episode.

In the UK public involvement group, researchers have noticed a confusion between postpartum psychosis and postpartum depression, as well as anxiety and postpartum obsessive-compulsive disorder (OCD), which can be associated with the heightened* stigma surrounding the disorder.

“One of the main barriers we also discovered was the fear of social services taking away children.”

Jessica shared further findings from this UK group, which included an acknowledgment that medication is a process of trial and error and that the research being conducted into postpartum psychosis needs to translated into clinical terms for healthcare professionals through training.

Cross-cultural aspects of postpartum psychosis

When comparing these discussions from groups in Malawi and India, Jessica explained some similarities, such as common symptoms of postpartum psychosis and the severe impact of an episode.

However, differences also included non-medical approaches to treatment such as the use of traditional and spiritual healers as well as labels used which related more to symptoms rather than the whole diagnosis.

Jessica concluded: “The take home message of this is that although postpartum psychosis does seem to present similarly across cultures […] there are important cultural factors that need to be considered for future research.”

Getting involved in mental health research

NCMH Director Professor Ian Jones highlighted the vital role the public play in mental health research by discussing the Mums and Mental Health study at the NCMH.

“There’s a lot we’ve learnt about postpartum psychosis already through research, but there’s so much more we still need to find out.”

Professor Jones highlighted further questions surrounding postpartum psychosis such what causes postpartum psychosis, as well as the best therapies which help women to get better.