Does Postpartum Psychosis Have a Cultural Aspect?

Dear Editor,

The process of becoming a mother, which is considered a happy event, can negatively affect the health and well-being of women in immigration scenes, which require adjustments¹. In addition to the many challenges that come with motherhood, women may experience a language barrier, discrimination, difficulty accessing health services, and social isolation². The social isolation of a migrant woman attempting to adjust to a new role postpartum increases the likelihood of experiencing psychosocial problems; as a result, she may be unable to fulfill her maternal function³. During the postpartum period, the susceptibility to psychiatric diseases, such as anxiety disorder, depression, and psychosis may increase⁴. Postpartum psychosis is one of the most severe psychiatric conditions that can occur after birth, and it is most commonly seen between days 3 and 14 after birth. Suicidal ideation and risk, thoughts or attempts to harm the baby, delusions, hallucinations, mood swings, violent behaviors, refusal to eat or sleep, and insomnia are the most common symptoms⁵.

Case

Ms. M is a 24-year-old, high school graduate Thai woman who has been living in Turkey for a year. Two weeks ago, she gave birth to a female neonate through a normal spontaneous delivery. The patient, who had met her Turkish husband via the internet, did not have a history of any psychiatric disorder during pregnancy or before. She was brought to the psychiatry service by her relatives; she had been suspicious of everyone around her, did not talk to anyone, refused to eat, and could not care for her baby. Since the patient’s Turkish and English communication skills were not sufficient, communication was provided in Thai using translation programs. She was diagnosed with postpartum psychotic disorder, and 5 mg/day of haloperidol was started. As per observation, the patient did not talk to other patients or staff during the treatment process and did not leave her room. After a while, her communication with her physician, who conversed with her in Thai, increased. During these interviews, it was learned that the pregnancy was unplanned, she was very afraid of childbirth, and she had problems with her husband’s family. She also explained that her husband had been away from home for a long time because he works in the international transportation business and that she communicated with other family members at home through him. On day 10 of her treatment, she was discharged with a partial recovery at the request of her family.

Cultural adaptation problems in the postpartum period may lead to psychiatric conditions because of a lack of social support and difficulties in diagnosis and psychotherapeutic interviews¹. Cultural values developed in line with social support, attitudes toward birth, beliefs, and traditions can play a predictive role in overcoming postpartum psychosis⁴. The transition to motherhood, which brings many vital changes, can be full of obstacles and risks for immigrant mothers. Annually, numerous people emigrate from their places of origin to different countries³.

Therefore, developing special care programs and health policies for immigrant mothers is important. Particularly, the professional skills and equipment of mental health workers will positively affect the lives of immigrant mothers and their families.