In Cyprus, a woman can go through her entire pregnancy, give birth and return home with her baby without anyone addressing her mental health. And if she is struggling, those difficulties are likely to remain invisible unless she recognises them herself and decides to speak out, or a healthcare professional happens to ask.
This is because Cyprus has no systematic screening programme, no defined referral process and no organised network of specialised perinatal mental health services.
That reality is described to Politis by Ioanna Papaioannou, a midwife, nurse and doctoral student at the Cyprus University of Technology (CUT), who is the lead researcher of the first nationwide study on maternal mental health in Cyprus.
Anxiety and depression
The study's findings highlight the urgent need for organised support.
Of the 474 mothers who participated in the research during the first year after childbirth, 36.8% recorded scores indicating possible depressive symptoms, 31.2% reported moderate to severe anxiety symptoms, and 42.3% showed low psychological wellbeing.
The results are based on self-report questionnaires and do not constitute clinical diagnoses, but they point to the need for further assessment.
At the same time, only 9.4% of participants said they were receiving professional help or treatment during the period covered by the survey.
Behind these figures are women trying to adapt to the demands of motherhood while often facing challenges that extend beyond caring for a newborn baby.
The CUT study, conducted as part of the European "Mind the Mum" project, highlights not only the psychological burden experienced by new mothers but also their childbirth experiences, the importance of family support and the need for organised interventions.
The research is based on questionnaires completed by 474 mothers during their first year after giving birth.
Most of the participants were aged 31 to 40, 93.4% had higher education qualifications and 91.1% were employed.
These characteristics should be taken into account when interpreting the findings, meaning the results cannot automatically be considered representative of all new mothers in Cyprus.
Help does not reach everyone
The gap between the needs identified by the study and the level of professional support mothers report receiving is a cause for concern.
A total of 36.8% scored above the threshold on the postnatal depression scale, indicating a high likelihood of depressive symptoms and the need for further assessment, while an additional 18.2% reported psychological distress that may be causing difficulties.
At the same time, 11.5% of participants reported a previous diagnosis of a psychological disorder or mental health problem, while 6.6% had received a diagnosis during the period of the study.
However, just 44 mothers, representing 9.4% of participants, said they were receiving professional help or treatment at the time.
The figures do not necessarily refer to the same women and therefore do not allow conclusions to be drawn about how many needed help but did not receive it.
Nevertheless, Papaioannou says the data point to a gap in identifying and supporting mothers.
According to a recent European review she cites, Cyprus does not carry out systematic screening for perinatal mental health and has no formal referral procedure.
The World Health Organization recommends screening for depressive and anxiety symptoms using validated tools, combined with support services, while Britain's NICE guidelines call for regular assessment of women's mental health.
In Cyprus, however, there is no organised network of specialised perinatal mental health services.
As the researcher explains, identifying difficulties often depends on whether women raise the issue themselves or whether a healthcare professional asks.
In other words, there is no structured mechanism linking early identification with appropriate support.
The childbirth experience
The findings concerning childbirth experiences are also noteworthy.
Although 83% of participants said they were generally satisfied with their childbirth experience, 63% reported receiving insufficient information during labour and 65% reported inadequate communication with healthcare professionals.
At the same time, 49% described childbirth as a painful experience.
Another finding showed that 39.1% of mothers were separated from their newborns after birth.
The study does not specify the reasons for or duration of these separations, meaning the figure cannot be interpreted on its own as evidence of a negative practice.
The research also found that 30% of women gave birth vaginally and 18.4% through assisted vaginal delivery.
A further 21.3% underwent emergency caesarean sections, 26.4% had planned caesareans for medical reasons, and 3.8% underwent elective caesareans by choice.
Addressing the apparent contradiction between high overall satisfaction and negative assessments in specific areas, Papaioannou said overall satisfaction may primarily reflect relief that both mother and baby are healthy.
However, when women assess specific aspects of the care they received, the picture changes.
The results do not allow a definitive overall judgment of maternity care in Cyprus, she said, but they do highlight room for improvement in communication and information provided to women.
The significance of the childbirth experience extends beyond the day of delivery itself.
The study found that the more satisfied women were with their childbirth experience, the fewer depressive symptoms they subsequently reported.
The finding indicates a correlation rather than a proven causal relationship.
Who struggles most
The research also examined factors associated with maternal mental health, identifying groups of women who appear to experience greater psychological strain.
The strongest depressive symptoms were recorded among women with a previous history of mental health problems.
Their average score on the depression scale was 14.8, compared with 9.4 among women without such a history.
The threshold suggesting a high probability of depression is 13, underlining the importance of identifying and supporting this group at an early stage.
Higher levels of depressive symptoms were also recorded among first-time mothers, younger women, those in more difficult financial circumstances and those with lower confidence in breastfeeding.
Smaller but statistically significant differences were also observed among women who experienced complications or gave birth by caesarean section.
Breastfeeding emerged as another important aspect of the experience of new motherhood.
Of those who answered the relevant question, 57.8% reported difficulties with breastfeeding.
In addition, among the 394 women assessed on a breastfeeding confidence scale, 28.2% reported low confidence.
Greater confidence in breastfeeding was associated with better mental health outcomes.
That does not mean that breastfeeding itself protects against depression, nor that choosing another method of feeding causes psychological difficulties.
The study also found that anxiety and depressive symptoms were closely linked.
Because the research is cross-sectional, however, the findings identify associations rather than proven cause-and-effect relationships.
The role of partners and family
Amid the concerning findings, the study also highlighted the importance of support networks.
A total of 80% of women reported high levels of support from their partners, 75.7% from family members and 57.4% from friends.
Partner support showed the strongest association with lower levels of depressive symptoms and better psychological wellbeing.
Family support followed, with support from friends also contributing, though to a lesser extent.
Papaioannou also notes that adaptive coping strategies, such as positive reframing and planning, were linked to better mental health outcomes.
The findings underline the importance of a supportive environment during the transition to motherhood, while recognising that such support cannot replace professional care when needed.
Three measures to change the picture
The researcher does not stop at identifying the problems. She proposes three specific interventions to improve perinatal mental health care in Cyprus.
The first is the introduction of routine screening during the perinatal period, using validated tools to detect depressive and anxiety symptoms by midwives, nurses and doctors.
The second is the creation of a clear referral pathway and specialised services so that women identified as struggling can receive timely and appropriate support, with particular attention given to those with a history of mental health difficulties.
The third is training healthcare professionals in communication and information-sharing during childbirth, as almost two-thirds of participants reported shortcomings in these areas.
At the time the findings were provided to Politis, the results had not yet been formally communicated to the relevant authorities and no official response or commitment to action had been received.
At the same time, the European "Mind the Mum" project is developing a pilot programme offering free empowerment and preparation sessions for expectant mothers across Cyprus through cooperation between CUT and the organisation Birth Forward.
The aim is to strengthen women's psychological preparation and provide support tools during the perinatal period.
Once the pilot phase is completed, the goal is for the programme to be made available to perinatal and mental health professionals throughout Cyprus.
