This post is by guest blogger Anna Fialkowska
Perinatal Depression or anxiety can be experienced at any time from conception to around one year after giving birth. It affects 10-20% of women and there is some evidence suggesting links to hormonal changes occurring during pregnancy and when giving birth. The onset is usually within 4-6 weeks, but it can also occur as late as 6 months after giving birth. The most common symptoms of Perinatal Depression include feeling down, upset, tearful, hopeless, numb and guilty. Affected individuals may also experience low self-esteem, irritability and a sense of unreality. Behavioural changes include sleeping difficulties, reduced appetite, lack of interest in sex, indifference towards a partner and poor bonding with the baby. Isolation and difficulty in relating to others are also very common (Milgrom & Gemmill, 2014).
The Baby Blues
The baby blues is a brief period of low mood characterised by feeling emotional and tearful. It can be easily confused with Postnatal Depression and is said to impact approximately 80% of women around three to ten days after giving birth. The evidence suggests that the baby blues are associated with hormonal changes, but also significant changes in sleep routine, learning to cope with new demands and subsequently increased tiredness and feelings of being overwhelmed. The feelings are usually manageable and normally disappear after a few days (Degner, 2017).
Perinatal Generalised Anxiety
Perinatal Generalised Anxiety is often co-morbid with depression and it is characterised by excessive worrying about the baby, fear of judgement and failure. The evidence suggests that mothers who have previously experienced anxiety can see these feelings re-activated in the perinatal period. Furthermore, symptoms of Obsessive-Compulsive Disorder (OCD) can also be experienced and are more common than initially thought. About 3 to 6% of women were shown to experience OCD symptoms including intrusive thoughts, for instance, thoughts about harming the baby, or compulsions about germs, infection or cleanliness. The risk of developing perinatal depression or anxiety is increased among those who have had depression previously, have a lack of support, had birth trauma, experienced domestic violence or experienced physical complications. Furthermore, individuals who are relatively older, or are refugees/asylum seekers are also at an increased risk of suffering from mental health complications during pregnancy or after giving birth (Fairbrother et al., 2016).
Psychosis
Postpartum Psychosis (PP) is a very rare mental health condition impacting one in 500 women who give birth. It is a severe complication that it is often unrecognised by an impacted individual and can be presented as severe depression or mania, or a mixture of both. The symptoms usually occur suddenly within the first month after birth. They can then disappear and reappear again by the three-month mark (NICE, 2014). A high number of affected women report symptoms within the first three days of having a baby. The early signs of PP include feeling high and excited, the experience of insomnia, increased energy levels and a strong desire for social interactions. More advanced symptoms include delusions, hallucinations, mania, loss of inhibition or severe mood swings. The risk of developing PP is higher among women with Bipolar Disorder and those who have experienced sexual or childhood abuse.
Consequences
While the baby blues are manageable feelings that usually disappear after few days, postnatal depression, anxiety or psychosis are much more serious conditions that may require professional support. Suicidal ideations are relatively common with these conditions and evidence suggests that the mother’s mental health during pregnancy can have a long term impact on the child. An increased risk of neurodevelopment abnormalities, such as anxiety, depression, behavioural complications, impaired cognitions, autism and schizophrenia are marked as common problems if a suffering mother is left untreated. Lower IQ levels, elevated violent behaviours, anger and separation anxiety are also more common among children whose mothers experienced depression during pregnancy. Therefore, appropriate management of the aforementioned conditions is crucial (Alhusen & Alvarez, 2016) for mother and child alike.
Paternal Depression
Interestingly, not only mothers suffer from perinatal depression. Approximately 5-10% of fathers experience paternal depression (Cameron et al., 2016), a figure which is often underestimated. Symptoms include feeling guilty, low and unworthy, and they are often expressed through irritation and anger. The avoidance of social contacts and withdrawal from family life is also regularly observed. According to the research, fathers can also suffer from Paternal Anxiety and PTSD, which can lead to serious mental health consequences if not addressed appropriately (Matthey et al., 2003; Bristow, 2016). However, research on paternal mental health is relatively limited and difficulties experienced by fathers are often underestimated. Mother and baby health is often a priority for family and health professionals, leaving struggling fathers without much support. Evidence suggests that 1 in 20 men experience mental health difficulties associated with becoming a father and therefore the impact of fatherhood on male mental well-being needs to be discussed and explored more.
Management
As noted, one in five women and one in twenty men will experience mental health difficulties during pregnancy, with depression and anxiety being the most common. Feeling low or overly anxious for a prolonged period of time during or following pregnancy is not a natural part of the perinatal period. However, as an understanding of these conditions continues to grow, many services offer support for these conditions. For example, the Maternal Mental Health Alliance (MMHA) is a charity providing high-quality support for individuals suffering from mental health difficulties during pregnancy. Furthermore, GPs, midwives, health visitors, Children and Family Services and private companies such as Sparta Health are available to provide help and support to parents who may be suffering following the birth of their child. With such an array of high-quality services available, no parent should have to suffer in silence anymore during a period that should be filled with joy.
Contact us today to see how Sparta Health can help provide mental health and wellbeing support to your organisation.
About Anna Fialkowska
Anna Fialkowska is a Trainee Health Psychologist, is completing her doctoral training at the University of the West of England and currently works as a Heath Improvement Practitioner. She has worked within the field of mental health dysfunction and cognitive rehabilitation over the last six years. Her main areas of research include the development of behaviour change interventions, the impact of stress on individuals’ physical health and the effect of chronic conditions on psychological well-being.
References
Alhusen, J. L., & Alvarez, C. (2016). Perinatal depression: A clinical update. The Nurse practitioner, 41(5), 50–55. https://doi.org/10.1097/01.NPR.0000480589.09290.3e
Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003). Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?. Journal of affective disorders, 74(2), 139-147.
Bristow, F. (2016). Paternal Posttraumatic Stress Following Childbirth: Towards a Theoretical Model (Doctoral dissertation, Royal Holloway, University of London).
Cameron, E. E., Sedov, I. D., & Tomfohr-Madsen, L. M. (2016). Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. Journal of affective disorders, 206, 189-203
Degner D. (2017). Differentiating between "baby blues," severe depression, and psychosis. BMJ (Clinical research ed.), 359, j4692. https://doi.org/10.1136/bmj.j4692
Fairbrother, N., Janssen, P., Antony, M. M., Tucker, E., & Young, A. H. (2016). Perinatal anxiety disorder prevalence and incidence. Journal of affective disorders, 200(1), 148–155. https://doi.org/10.1016/j.jad.2015.12.082
Milgrom, J., & Gemmill, A. W. (2014). Screening for perinatal depression. Best practice & research. Clinical obstetrics & gynaecology, 28(1), 13–23. https://doi.org/10.1016/j.bpobgyn.2013.08.014