Postpartum psychosis (PP) is experienced by women across sociodemographic boundaries, but little research has been done to address the complications of treating PP in non-native language-speaking patients. PP is difficult to study as it is due to its rarity, but it is integral to prevention and treatment of PP that clinicians be aware of the complexities of this disorder. A recent case report by Naito and colleagues examines a case of PP experienced by a Japanese-speaking woman. Ms. K, as she is referred to in the report, presented in the emergency room (ER) after an attempt to harm herself with depressed mood and suicidal ideation. At this ER visit, she was one week postpartum after giving birth to a baby boy. The pregnancy and birth were uncomplicated, and Ms. K did not have any significant medical issues except for a history of hypothyroidism. Ms. K was a recent arrival to the United States and spoke very limited English.
Ms. K’s doctors and nurses were able to obtain a history, but with difficulty. They relied heavily on the reports of Ms. K’s husband since she spoke limited English and expressed distrust towards the telephone translation service offered. Since much of the diagnosis of PP relies on report of symptoms, this was a major challenge to diagnosing Ms. K with PP. She was admitted to an inpatient psychiatric unit so that doctors could monitor her symptoms.
While hospitalized, Ms. K expressed feeling as though she was in a “dreamlike state” and said that her “internal clock was broken and still stuck at the point she gave birth to her baby”. Further information was gathered during this time on Ms. K’S psychosocial supports, which were limited due to her husband working long hours, isolation from other family members in Japan, and difficulty meeting people in the US due to the language barrier. Ms. K did eventually reveal to staff that she had a history of depressive symptoms, although she noted that her husband and family were not aware of this history. On her third day of hospitalization, Ms. K told a Japanese-speaking staff member that she was hearing voices, and she was started on an antipsychotic medication. She was discharged three days later with follow-up from Japanese-speaking providers to maintain her psychiatric care.
While some general risk factors for PP are known, this case report presents several risk factors that are specific to Ms. K’s experience as a non-English speaking Japanese immigrant. The main risk factor was lack of support in the perinatal period due to her husband’s employment situation, being separated from family supports, not speaking English, and being in an unfamiliar environment. Lack of perinatal support has been linked in the literature to higher risk for postpartum depression, and has been shown to increase rates of PP in other cultures based on two separate studies [1, 2].
This is one specific case, but it can be applied more broadly to treatment of PP in all non-native language speakers or where there is a cultural difference. In addition to experience-specific risk factors, there are experience-specific barriers to accessing care such as language barriers which contribute to the difficulty in PP identification and challenges in providing psychoeducational support, as well as cultural stigma around mental health. Better resources for immigrants and non-native language-speakers are needed to allow them to access the care they need across the healthcare system but specifically in the case of PP where early detection and treatment are so crucial.
Research summary compiled by Nicola Roux.
Naito, T., Chin, J., Lin, J., Shah, P. J., & Lomiguen, C. M. (2019). Postpartum psychosis in a non-native language–speaking patient: A perspective on language barriers and cultural competency. General Psychiatry, 32(3), 1-4.