1 in 20 pregnant women contemplate suicide: Study reveals alarming crisis

A crucial national policy dialogue convened on Tuesday, November 27, has thrown a spotlight on a hidden mental health epidemic among mothers and expectant women in Ghana.

Disturbing findings from a four-year research project reveal that a staggering 5% of pregnant and new mothers have had thoughts of ending their lives in the preceding month, demanding an immediate integration of mental health services into routine primary healthcare.

The meeting at the Ghana College of Physicians and Surgeons (GCPS) was held to disseminate the results of the RESPONSE research project, a comprehensive study that analysed the mental health burden across the healthcare ecosystem.

The Maternal Emergency: Data From the Field

The study, spearheaded by the London School of Hygiene & Tropical Medicine (LSHTM) in partnership with the Ghana Health Service – Research and Development Division (GHS RDD), drew its findings from 42 months of research, including a six-month pilot intervention in six primary health facilities within the Prampram-Ningo and Shai-Osudoku districts of the Greater Accra Region.

It was funded by the UK Medical Research Council, the Foreign Commonwealth & Development Office (FCDO) and the Wellcome Trust.

Researchers screened over 2,000 antenatal and postnatal women using the World Health Organization’s Self-Reporting Questionnaire (SRQ-20).

The stark data highlights the scale of distress:

• 28% of the women screened scored ≥6 on the SRQ-20, the widely recognised threshold for mental distress.
• Most critically, 5% of all women interviewed admitted that thoughts of suicide had crossed their minds in the past 30 days.

Professor Irene Agyepong, Co-Principal Investigator and Ghana Team Lead for the project, challenged the traditional medical focus, stating:

“Traditionally, we focus only on postpartum depression, but our data shows the problem often starts during pregnancy.”

This is supported by the figures showing that 36% of pregnant women (antenatal clients) exhibited signs of distress, compared to 25% of postnatal clients.

Vulnerable Groups: Teenagers and Loss

The study identified certain demographics facing an alarmingly higher risk profile:

• Adolescent Mothers (Aged 14–19): Of the 172 teens screened, 43% showed signs of mental distress. This is nearly double the rate of the general adult population, which stood at 27% among women aged 20 and above.
• Pregnancy Loss: 50% of women who had experienced pregnancy loss showed elevated signs of mental distress.

The researchers emphasised that the high rates of anxiety and stress are not just individual problems but indicators of systemic failure. Prof. Tolib Mirzoev, Principal Investigator of the project, stressed the need for a cultural shift in the health sector.

“Health systems’ responsiveness is a critical aspect of performance. Prioritising responsiveness to both patients and staff, particularly in mental health, is essential,” he remarked, noting the pervasive stigma that often impedes both patient and provider from seeking mental health support.

Dr. Bertha Garshong, a researcher on the project, stressed that any national scale-up must ensure targeted attention for adolescent mothers and women who have suffered pregnancy loss, as they are among the most vulnerable.

Piloted Solutions: From Screening to Specialist Care

To tackle this crisis, the RESPONSE project piloted a scalable screening and referral intervention:

• All pregnant and postnatal women attending primary health facilities were given the SRQ-20.
• Women scoring ≥6 were immediately referred to mental health nurses trained in the WHO’s Mental Health Gap Action Programme (mhGAP), adapted specifically for the Ghanaian context.
• Based on the nurses’ detailed evaluation, care was either provided at the local primary care level or escalated to specialist care, such as to clinical psychologists or psychiatrists, including those at Pantang Hospital.

Frontline Workers Also At Risk

The findings highlighted a parallel crisis of burnout among the caregivers themselves. The study revealed that frontline health workers are under immense psychological strain:

• 51% experienced moderate to extremely severe anxiety.
• 40% reported moderate to extremely severe stress.
• 37% reported moderate to extremely severe depression.

Prof. Agyepong reiterated the critical link between staff and patient health: “Health workers told us clearly: ‘If you want us to care for patients’ mental health, you must first care for ours.’”

The Call for Policy and Financing

Delivering the chairperson’s remarks, Dr. Frank Atuguba, Director of the Dodowa Health Research Centre, urged the Ministry of Health and Ghana Health Service to act immediately by making three specific policy commitments:

1. Revise the National Reproductive Health Guidelines to formally include mental health screening.
2. Allocate dedicated budgets for both maternal and frontline health worker mental health support.
3. Explore sustainable financing structures, prioritising the integration of these services into the National Health Insurance Scheme (NHIS).

Prof. Agyepong concluded the dialogue with a powerful summary of the findings, stressing that the evidence is clear:

“Maternal and health worker mental health is not a luxury—it is foundational to achieving universal health coverage and the Sustainable Development Goals… The question is no longer ‘if’ but how quickly and how well we act.”

Participants committed to forming a Technical Working Group to expedite the exploration of national scale-up strategies and monitoring systems to institutionalise the pilot-tested tools.

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