Doctoral Degrees (Psychiatry)

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Browsing Doctoral Degrees (Psychiatry) by Author "du Toit, Elizabeth"

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    Maternal mental health : a prospective longitudinal cohort study of the outcome of planned versus unplanned pregnancy in women with major psychiatric disorders in a developing country
    (Stellenbosch : Stellenbosch University, 2020-03) du Toit, Elizabeth; Koen, Liezl; Niehaus, Daniel Jan Hendrik; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY: Unplanned pregnancy is a global public health concern due to its associations with risky prenatal behaviours and compromised maternal mental health. Women in developing countries are especially vulnerable to unplanned pregnancy and the associated adverse outcomes. In order to meet the Sustainable Development Goal of the United Nations regarding the reduction of maternal mortality and morbidity, unplanned pregnancy needs to be addressed contextually. Yet, due to its complex and dynamic nature, pregnancy planning remains a difficult concept to define, and is often viewed (and researched) in limited and limiting ways. Like unplanned pregnancy, peripartum psychiatric illness is a pertinent health concern. Psychiatric illness during pregnancy is associated with poor obstetric outcomes, increased rates of substance abuse, decreased use of antenatal services, and increased risk of postpartum psychiatric symptoms. Although both unplanned pregnancy and psychiatric illness during pregnancy are highly prevalent and associated with compromised birth outcomes, very little data is available regarding the impact of unplanned pregnancy on women with mental illness living in a developing country. It has been suggested that pregnancy planning may ameliorate the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. This research project aimed to address the lack of carefully collected data on pregnancy planning in South African maternal mental health patients. The project was based on the observation of patients within two “real real-world” practices. It is divided into four parts, each exploring a different aspect of the central theme and contributing to the conclusion. The research aims were: 1) to identify risk factors for unplanned pregnancy among South African women with mental illness; 2) to use the London Measure of Unplanned Pregnancy to explore the complexities of unplanned pregnancy in women with mental illness; 3) to identify risk factors for adverse birth outcomes, focusing on the role of unplanned pregnancy; and 4) to explore suicidality among women with mental illness during the perinatal period. Results suggest that there are various risk factors for unplanned pregnancy among South African women with mental illness, with some directly related to the mental illness and others rooted in the socio-demographic sphere. The data revealed that dichotomous questioning is not the most effective way of determining pregnancy intent, and that better insights may be gained by using more nuanced measuring tools. This is especially imperative in the light of results confirming unplanned pregnancy as risk factor for adverse birth outcomes in this group of vulnerable women. Although unplanned pregnancy in itself was not a risk factor for heightened suicidality, the interactions between pregnancy planning and employment status underlined the importance of addressing both mental health issues and fertility planning contextually. Knowledge gained from this project may aid in justifying the importance of nuanced screening tools for identifying pregnant women at risk of psychiatric illness on the one hand, and psychiatric patients at risk of unplanned pregnancy on the other. The results make a strong case for integrated, holistic health care solutions, in which education can play a key role.