Dr. Slavica Arsova isn’t just a psychiatrist; she’s a champion for mothers and families in Macedonia.

Dive into her inspiring journey as she empowers women through mental health advocacy, breaks cycles of prenatal anxiety, and creates stronger support systems.

Discover how her dedication transforms lives and uplifts communities.

Dr. Arsova’s story is one of unwavering passion. Her groundbreaking initiatives and deep empathy for mothers shine bright, making her name synonymous with hope and a brighter future for mental health care for mothers and their families.

In this article, we will talk with Dr. Arsova about her life and work as a psychiatrist, as well as her emotional connection with patients and her dedication to mentoring future psychiatrists.

Her most powerful statement, “Proper care for the mother’s mental health is care for the entire society,” sums up her vision for a healthier Macedonia.

Dr. Arsova’s passion for improving maternal mental health and building a stronger mental healthcare system in Macedonia speaks to her ambition and belief in positive change in our country.

So, let us dive into our interview!

The interview

Can you tell me about your education and professional training as a psychiatrist? Where did you study, how many years, details about your education including specifics about your degree, such as your area of expertise?

Hi there, Irena! In 1991, I received my degree from the “University of St. Cyril and Methodius” in Skopje’s medical faculty.

To be very honest, I didn’t have any major issues when I was studying; I finished on time with an average grade of 9.1 and I was interested in a variety of subjects.

When the time came to choose a specialization, it came down to two areas – Psychiatry and Gynecology, but in the end, I ultimately decided on psychiatry and never regretted it.

Subsequently, I completed a 4-year specialization in Psychiatry in 1998, achieving good results and obtaining the title of specialist in psychiatry.

In the following period, I attended a lot of training sessions and seminars, especially in relation to certain psychotherapeutic approaches such as psychodrama, as well as training in social psychiatry, and later, a subspecialization in psychotherapy.

Along with clinical developments, I pursued academic advancements. I completed my master’s on the topic “Sexual dysfunctions in certain psychiatric disorders” and later obtained my doctorate on “Quality of life in patients with schizophrenia“.

Although I’ve devoted almost my entire career to working as a psychiatrist in the daily hospital, where our patients vary widely in age and psychiatric issues, the facility also functions as a diagnostic and treatment center for patients with chronic mental illnesses and those who are trying to reintegrate into society.

Since 2014, I’ve become especially interested in women’s mental health, with a focus on postpartum and pregnancy mental health. It was my initiative to open a treatment center for these vulnerable women during this critical period of their lives.

In the daily hospital and the treatment center that I manage, we are a team of psychiatrists, psychologists, social workers, defectologists, occupational therapists, and highly educated trained nurses.

As for my academic success, I gradually progressed in this area, first as an assistant in the department of psychiatry, then assistant professor, associate professor and currently I am a full time professor and recently been appointed as the head of the department of psychiatry and medical psychology.

What was your initial desire to become a psychiatrist? Or What made you decide to pursue a career in psychiatry and how long have you been practicing?

I’ve been a psychiatrist since 1998, and I have to acknowledge that, I am completely satisfied with it, in spite of the significant responsibility this job entails, particularly in treating people’s mental illness, because you have “swallow“ so to speak all the burden, and just offer understanding and proper help.

I can’t precisely pinpoint what prompted me to choose psychiatry, but I believe I somehow knew I had enough empathy for people’s mental anguish and the capacity to help those in need.

What is it like to be a psychiatrist in North Macedonia?

Hmm, being a psychiatrist in Macedonia… I suppose that our field is universal; mental disorders or difficulties are similar worldwide.

There are certain differences influenced by societal, cultural, and environmental factors, as well as working conditions, which I believe might be better in some countries.

However, the most crucial factor is the human aspect, namely the psychiatrist and their relationship with the patient.

What is psychiatry to you, considering your experience so far?

Psychiatry is a medical science dealing with mental disorders, their diagnosis, and a combined treatment involving pharmacological, psychotherapeutic, and psychosocial approaches.

What’s important in our work is teamwork, meaning daily collaboration with other health workers and collaborators.

Is it challenging to study psychiatry in Macedonia and contribute to the practice in our country? Have we made progress, and what kind?

The entire process isn’t easy but is creative and interesting. It requires sacrifices, self-work, dedication and persistence, and additional education beyond formal specialist training.

I hope there’s progress because many young doctors are interested in this field, enthusiastically engaging in the educational process.

I think we, as educators, are more open to collaborating with both students and specialists.

Being a good psychiatrist doesn’t just mean having patients; it’s also about imparting knowledge and skills to those in the learning process.

What does a day in the life of a psychiatrist in Macedonia look like?

It varies depending on where the psychiatrist works.

As a clinical psychiatrist, I’m involved in outpatient care, work in my department and others shifts, but also working with students and trainees in lectures, seminars, exercises.

How do you cope with disappointments and perhaps temporary depressive states as a healthcare worker, and what advice would you give to younger generations in this regard?

Disappointments have always existed and will continue to exist, such as occasional personal failures or overcoming certain obstacles in the learning process or during therapeutic processes with patients.

However, we’re only human, and we’re not all-powerful to solve all our patients’ health problems. What most important is the acknowledging and overcoming certain professional mistakes.

All of this can be facilitated not only by using literature but also through consultations and support from other colleagues.

How does a psychiatrist take care of their emotional well-being despite daily involvement with patients who need help? How do you balance your work as a psychiatrist with self-care and well-being?

In terms of self-care, it’s crucial, just like for anyone else, to focus on daily health, include nutrition, do regular physical activity, have a good sleep, to socialize, spend time with their family, and to have good collaboration at work.

Regarding specific difficulties, it’s beneficial to practice “weekend detox” from the work process.

That’s why in the daily hospital, every Friday, we go outside the institution with some of the patients, visiting museums, theaters, nature, etc. And later, together with the team, we share our experiences and preoccupations.

Do you sometimes pause and reflect on yourself as a psychiatrist in relation to your life and the work you do?

Certainly, I consciously pause at times, plan for it, and sometimes, my body and mind signal the need for rest.

Do you have ways to relax and take time off?

I have many friends, a large family, and I spend a lot of time with all of them, which, honestly it really fulfills me.

Besides, I attend dance classes and I have two dogs, beloved pets, that always by my side.

Apart from them, I spend time with friends who also have pets. And In spare time, I enjoy reading.

What do you consider as beauty in your profession?

The beauty in our profession is undoubtedly the result of our work.

When you restore joy to someone, bring peace, when their connection with others is restored, when you help someone in resuming duties such as husband, parent, employee, friend; when you help a woman in embracing motherhood and enjoying that role as a mother, connecting her with her baby and child. That’s the beauty!

Are you involved in any research, publications, or community initiatives related to mental health?

I have numerous research studies and works published in journals covering various topics, from schizophrenia disorders to women’s mental health.

Additionally, I’m involved in several projects focusing on improving the quality of life for patients through better relationships and identify problems among pregnant moms.

Can you describe your philosophy and approach to patient care and treatment?

My philosophy is to be present for the patient, to establish a genuine relationship with them as the bond itself promotes recovery.

With which group of people (patients) do you mostly work, and with whom would you like to further focus after years of working in psychiatry?

As the head of the daily hospital, I work with various patient groups and ages, including both acute cases and individuals with chronic health conditions.

This involves patients with neurotic disorders like panic, anxiety disorders, with depression, or psychotic disorders.

Apart from these, I find it personally fulfilling to help women in their pregnancies and postpartum periods; I provide group sessions for them, in my clinic office, once in a week.

Do we, as a nation, show interest in seeking help from psychiatric centers in North Macedonia if we or someone close to us has a mental problem?

The desire of patients seeking psychological help and mental health care has increased in recent years. This might be attributed to a rise in mental health issues or a collective maturity regarding the importance of mental health for everyone.

At the recent 7th Psychiatric and Neurological and 2th in Dementia Congress held in October in Ohrid, many students and specialists showed immense respect for your involvement in educating them in psychiatry.

How does this experience as a mentor to younger generations impact you, and what personal and professional legacy do you aim to leave for them?

Well, I am in great communication with young colleagues, I love that I am constantly open to their questions, I hope that I support them, both personally and professionally.

I think that the same is very important, so that the young colleague enters the profession without fear;

Sometimes encouragement is needed, sometimes help in certain crises, both professional and personal, and I think that a good mentor should follow his younger colleague in all fields of his functioning and literally take care of him.

Let’s discuss the care for mothers (women during pregnancy and one week after childbirth) during the COVID-19 pandemic and how this period affected their health, as mentioned in your study ‘Subjective Quality of Life of Women in the Perinatal Period: A Post Covid-19 Pandemic Exploration in North Macedonia.’

The research caught my attention.

You conducted all of your research from an analytical point of view, focusing primarily on women during the Covid pandemic.

You also focused on identifying the problem areas, namely how to support the female population, particularly during the period of pregnancy and the week following it, which you mention in your paper as being the most vulnerable for this category.

You found from the same survey/questionnaire that the most common issue during the pandemic was domestic violence, and that we should pay close attention to this problem.

Other issues include the small percentage of artificial abortions (approximately 3%), as well as the small percentage of social and recreational aspects of the surveyed women’s lives during the pandemic.

Your research showed a prevalent occurrence of violence during the pandemic. How can we eliminate this negative aspect, particularly the violence against pregnant women? And how to get even this society of ours involved in helping women – in preventing violence against them, especially if it comes to pregnant women?

This terrible phenomena of violence has become increasingly common not just in our nation but around the world, particularly during times of crisis.

Children who witness domestic abuse as they grow up become insecure adults who are prone to anxiety, depression, and other anxiety-related disorders.

They also experience dread, distrust, and poor communication skills.

In addition to the characteristics of a traumatized person listed above, women from such families or who experience ongoing partner violence are particularly vulnerable to health problems, including self-harm or suicidal thoughts, withdrawal, and neglect.

How can society get involved in helping women, particularly in preventing violence against them, especially when it comes to pregnant women? How can we influence public awareness to prevent violence against any woman?

Violence should never be applied to anyone; no one has the right to harm another individual in any way.

We must coordinate activities across the legal, health, and education sectors, to decrease this bad phenomena, which predominantly impacts women, children, adults, and vulnerable persons.

All educational institutions must provide constant instruction to students beginning at a young age.

Security structures must also get training in order to quickly and effectively handle abusers, and healthcare personnel must be prepared for early victim identification and response.

What steps may be taken to enhance the lives of women in our society?

Joy and contentment in all facets of life, including responsibilities as spouses, mothers, workers, and community members, are components of a high quality of life.

To improve this attribute, one must optimize every element that leads to increased efficiency and a higher standard of living.

This entails treating women fairly in both the home and workplace, attending to their needs at different phases of life, and providing for the physical and mental well-being of those who are vulnerable, such as low-income women, single mothers, and victims of violence.

What type of artistic and educational content can contribute to improving the lives of women, particularly those who are pregnant, in order to stop violence against them?

I’ve conducted several workshops using psychodrama therapy, which has had a positive impact.

Participants found it easier to express their psychological issues and find solutions with support from the group.

Would a series of seminars and public speeches emphasizing on supporting and protecting women from abuse have a significant beneficial influence on the lives of women in North Macedonia, particularly on pregnant mothers?

Increasing workshops and seminars on this topic would undoubtedly lead to greater awareness and the acquisition of new social skills necessary to deal with the challenges faced by women today.

The measurement of participant responses using the WHOQOL-BRIEF scale is discussed in the same article (‘Subjective Quality of Life of Women in the Perinatal Period: A Post Covid-19 Pandemic Exploration in North Macedonia‘) – and it is noted in several tables that following the pandemic, participants provided positive feedback about living a healthy life, including how well they lived it, whether they got enough exercise, whether their surroundings were truly healthy, whether they were satisfied with their daily lives, whether they had enough money for their needs, etc.

Surprisingly, among patients who were not mentally impacted by the epidemic, there was a significant rise in the percentage of them who expressed satisfaction and positivity about their mental and physical health as well as their living environment.

However, given the state of our economy and the fact that women (including pregnant women) frequently remain silent when it comes to domestic abuse—violence that they rarely talk about or open up about with you as their psychiatrist—what is your professional perspective as a psychiatrist who examined each of these participant-patients and your real perspective even among those who were not as affected by the pandemic?

It is positive that the research indicates a greater awareness of everything that would mean one’s own quality of life, and it is expected that during a pandemic it is not possible due to numerous restrictive measures but also numerous fears to satisfy all aspects of the quality of life.

Namely, studies in the world have shown that those people who, for example, continued with their routine habits such as physical activity even at home, and who made an effort to maintain social interaction in any way, coped better with the crisis itself.

On the other hand, how did those pregnant women cope, who experienced more anxiety, stress and psychological pressure during the pandemic, and how did they manage to overcome those difficult moments and fears even during their pregnancy?

And the study showed that those women who were either directly or indirectly impacted by the pandemic—that is, those who caught the virus, those who lost a loved one to the disease, and those who experienced a financial setback —showed higher levels of anxiety and depression.

Anxiety and depression among pregnant women during COVID-19 are closely linked to the fear of infection, for both themselves and their unborn child, fear of separation from their baby as well as fear of not being able to seek help from their gynecologist or doctor in time.

How did you assist pregnant women in Macedonia who were concerned about their babies during their pregnancy amid the COVID-19 pandemic?

The cabinet for treating women during pregnancy or after childbirth and the support groups that adhered to Covid restricts both operated throughout the epidemic, as help for these women.

How did you provide help and support to the same patients, during the pandemic who were having mental health issues but were finding it more difficult to seek assistance from a psychiatrist or other medical professionals?

During this period, we very quickly switched to the telepsychiatric way of working in combination with face-to-face therapy, and I can say that this approach (method) was quite successful.

Namely, telepsychiatry has allowed us to maintain consistent, uninterrupted communication with expectant and new mothers without interfering with their comfort in their homes.

At the same time, it has provided us with an excellent opportunity to observe their family dynamics (their family environment) and the conditions in which they live.

Let us discuss the RAS MEDICAL SCIENCE Research Article titled as”Covid-19 pandemic and postnatal depression, risk factors for postnatal depression.”

According to this research on depression among pregnant women in Macedonia during the pandemic, you discovered that Risk factors for perinatal depression were registered in 68.5% of participants, out of which 48.1% reported a posttraumatic stress condition, 42.6% had a history of mental health issues and 13% reported intimate partner violence.

The prevalence of registered risk factors corresponded to a study conducted in North Macedonia in 2020 , where the largest percentage of reported risk factors (42%) were previous episodes of mental health issues, and posttraumatic stress condition was reported as a risk factor by 40.6% of the participants.

Among the other risk factors with high percentages presented in that study were unintended pregnancy and family violence.

You also stated that: “The accentuated vulnerability for mental health disorders in this period is attributed to the interconnected physical, metabolic, hormonal and psychological factors and their interplay in the context of the socio-cultural field.

Some of the established risk factors for perinatal depression include: previous history of depression or family history of depression, stressful life events, low social support (perceived or received), marital relationship, intimate partner violence, unplanned pregnancy, hormonal changes, obstetric complications, ethnicity, maternal age, etc.

When the vulnerabilities of the postnatal period are combined with the impact of the COVID-19 pandemic, psychosocial outcomes are likely to be affected further.

The conclusion you are drawing from this research is: “Covid-19 pandemic has a serious impact on mental health of the entire population, especially on vulnerable groups like women in perinatal period in interplay with other risk factors for perinatal depression like PTSD, previous episodes of depression, violence, unplanned pregnancy“

What is your perspective on depression among women in Macedonia, particularly those who are pregnant?

Prenatal and postnatal depression rates in Macedonia are around 15%, similar to global rates, with an increase during the pandemic. Those who suffer in silence, from shame, fear, prejudice etc. are not included in this statistic.

How do you support and provide treatment for these women as a psychiatrist?

Treatment involves a combination of psychopharmacological and psychotherapeutic approaches, both individually and in groups.

In the therapy process are involved psychiatric professionals, psychologists, occupational therapists, and specialized doctors.

Since prenatal depression affects the entire family, it is better if the spouse or another family member is involved during the entire process.

A depressed mother is unable to care for herself, her infant, or any other children in the home. She also puts her spouse at danger of getting depression, affecting their relationship.

How did the previous diagnosis of depressive and anxiety disorders of female patients affect even more stress and anxiety during the pandemic, and even the appearance of a more severe form of depression?

It is considered that one of the risk factors is a past depressive episode that was often not recognized, was not treated, and during pregnancy this psychological condition worsens.

However, mothers who experienced such an episode may also have other risk factors, such as unplanned pregnancy, have reduced care for one’s health in general, they are underage mothers, or it can be other risky behavior.

Your research also concluded that Intimate partner violence was reported as a present risk factor in 13% of the interviewed participants in your study.

Intimate partner violence (IPV) during pregnancy is a serious public health issue with significant negative health consequences for women and children.

Tell us about your experience and thoughts on that conclusion. Also, how can we help our society avoid situations like this one?

Women who experience or have experienced long-term family or partner violence, develop what is known as complex post-traumatic stress disorder (CPSD), which is characterized by long-term anxiety-depressive states, constant feelings of fear, shame, insecurity, and mistrust, as well as constant feelings of guilt that they may have had any role in the abuse they endured.

They hardly get close and are not open to communication precisely because of the feeling of fear and mistrust.

The statement, in your article “Systemic Solutions for Addressing Early Recognition and Treatment of Antenatal and Postpartum/Postnatal Depression in Psychiatry Clinic in Skopje, North Macedonia“ said: “Proper care for the mental health of the mother is the care for the entire society.”

This was one of your powerful conclusions that really resonates with us.

Tell us a little bit more about this and how you came to this conclusion?

The conclusion is derived precisely from the importance of creating a strong mother-child bond, particularly in the first year of life.

Specifically, children who are raised by mothers who experience depression face challenges in their emotional and cognitive development, as well as an increased likelihood of experiencing depression in the future.

On the other hand, kids raised by mentally well moms benefit from a home atmosphere that encourages disciplined development, sound growth, and the formation of healthy personalities.

In other words, this conclusion emphasizes the importance of establishing a quality mother-child relationship in the child’s development.

Which of the publications served as your primary source of inspiration during the writing and research process, and where do you think you will next proceed to further advance the discipline of psychiatry?

I’m planning to focus further on the psychiatric aspects of pregnancy, especially concerning ethical and medical aspects of pregnancy including schizophrenia or bipolar affective disorders.

Last but not the least, we want to know, do you ever wish to write your own autobiography in which you would include not only your professional background, accomplishments, and works, but also your personal life as it progressed and moved through the axis of psychiatry?

I have contemplated this topic, but it requires significant effort and dedication. Perhaps such a creation will leave an indelible mark on the readers.

So I have thought about this topic as well, but it all takes a lot of time and attention, so perhaps this sort of fruit will emerge in the future and leave an impression on the readers.

Conclusion

Dr. Slavica Arsova’s story is one of unwavering dedication, groundbreaking initiatives, and a deep-seated passion for improving the lives of mothers and families in Macedonia.

She emphasizes the importance of understanding and connecting with patients on an emotional level.

Her career path reflects a commitment to her chosen field – psychiatry.

Dr. Arsova involvement in research and publications indicates a willingness to share knowledge and learn from others.

She is visionary and optimistic. Dr. Arsova’s passion for improving maternal mental health and building a stronger mental healthcare system in Macedonia speaks to her ambition and belief in positive change.

We are so proud to have such a wonderful woman as she is! And we hope to see even more improvements in her career as she advocates further for the mental health of mothers in North Macedonia!