Postpartum Depression: When Motherhood is Not a Happy Time


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Postpartum Depression (PPD): A Psychological Disorder

Postpartum Depression (PPD) is a fairly common complication of childbirth and often accompanies the postpartum period, leading to psychological suffering for the mother, negative effects on the infant and strained family relationships.1

Pregnancy, childbirth and the postpartum period involve intense emotional experiences for most women and are characterized by a major developmental transition, physical and psychological demands, body image changes, as well as psychosocial changes, all within a short period of time.2 Sadly, psychiatric disorders are the leading cause of maternal deaths, very often through suicide.1

Women with PPD suffer from depressive mood and profound sadness, frequent crying, insomnia, lack of appetite, fatigue, lack of motivation, low self-esteem, perceived inability to cope, suicidal ideation as well as multiple physical complaints.3,4

Some researchers attempt to conceptualize PPD as a complicated maternal identity formation, where the new mother is unable to achieve a sense of maternal competence and incorporate her new psychosocial role.3 In other words, there is a dominating American middle-class perspective on mothering, which expects an intense child-centered parenting that is both economically and emotionally demanding. Yet, we often fail to appreciate the largely diverse population of the United States in the context of child rearing. Thus, mothers who may not fit the middle-class American script may feel like a failure and begin to experience growing maternal incompetence, diminished self-efficacy, self-esteem and increased distress. All of these may be contributing to the onset of PPD.3

Why is this Disorder Often Undiagnosed?

Women diagnosed with PPD often describe themselves as “bad mothers” and report intense feelings of guilt and shame.3, p.374  This gives us an idea about the social stigma associated with PPD and would partly explain why most women do not seek professional help and remain undiagnosed and untreated. That is why helping professionals need to put every effort into promoting psycho-education and establishing PPD as a diagnosable, treatable disorder, so that no mother and her child remain in suffering. In fact, researchers point out that some women may experience the diagnosis of PPD as a relief, helping them accept their symptoms and reduce their personal feelings of guilt, self-blame and shame.3

How Common Is The Disorder?

The estimated prevalence rate of PPD is about 13%, with higher incidence among teenage mothers.5 A study of women in Sweden has shown depressive symptoms in around 17% of pregnant women during the late stages of pregnancy and in 13% of new mothers.6 Other studies have found prevalence rates of 14% in both early pregnancy and during the first year after delivery.Rubertsson cited in 6

Such prevalence rates pinpoint PPD as a serious public health issue that affects not only mothers, but also their children and other family members.

Risk Factors

Many life events and psychological factors have been identified as risk factors for PPD. Among these, anxiety and depression during pregnancy have shown to be strong predictors for the onset of PPD.7 Many studies have also established low socioeconomic status as a strong risk factor.3,6 Obese pregnant women are also at higher risk of developing PPD.7

Postpartum depression might be more common than you have imagined. It is not as common as “baby blues” also referred to as “postpartum blues” that affect about 75% of new mothers within the first ten days after delivery.8,9 PPD’s symptoms are more serious and longer lasting than those of postpartum blues. Still, if your wife, partner, or friend is experiencing such profound sadness, you should not underestimate the possible seriousness of the issue. Pay close attention to the symptoms and provide support and understanding. (An article on prevention and treatment will be posted soon).

References:

1. Bick, D. & Howard, L. (2010). When should women be screened for postnatal depression? Expert Reviews of Neurotherapeutics, 10(2), 151-154.    2. Clark, A., Skouteris, H., Wertheim, E. H., Paxton, S. J., & Milgrom J. (2009). The relationship between depression and body dissatisfaction across pregnancy and the postpartum. Journal of Health Psychology, 14(1), 27-35.   3. Abrams, L. S. & Curran, L. (2011). Maternal identity negotiations among low-income women with symptoms of postpartum depression. Qualitative Health Research, 21(3), 373-385.   4. Cho, H. J., Kwon, J. H., & Lee, J. J. (2008). Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei Medical Journal, 49(4), 553-562.   5. O’Hara, M. W. & Swain, A. M. (1996). Rates and risks of postpartum depression: a meta-analysis. International Review of Psychiatry, 8, 37-54.   6. Claesson, I., Josefsson, A., & Sydsjo, G. (2010). Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.  BioMed Central Public Health, 10, 766-776.   8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

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